INCIDENCE OF ACUTE KIDNEY INJURY IN NEUROSURGICAL PATIENTS TREATED WITH HYPERTONIC SALINE: RETROSPECTIVE OBSERVATIONAL STUDY

Abstract

SESSION TITLE: Tuesday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM PURPOSE: Cerebral edema in the neurosurgical population can cause intracranial hypertension leading to neurological deterioration. Hypertonic saline (HTS) has become a mainstay for the treatment of cerebral edema given its ability to reduce the rate of neuronal injury by increasing intravascular tonicity. The resulting hyperosmolar state shifts water from the intracellular compartment to the intravascular space. However, treatment with HTS has been shown to be associated with a higher incidence of acute kidney injury (AKI), contributing to higher mortality and morbidity. Despite being widely used, studies investigating the incidence and predictors of nephrotoxicity are lacking and there is no recent data regarding the risk of AKI. The aim of this study is to determine if hypernatremia is associated with an increased incidence of AKI in the general neurosurgical population treated with hypertonic saline. METHODS: We conducted a retrospective review of patients admitted to the neuro-intensive care unit at a tertiary medical center between January 1, 2015 and September 31, 2017 who had a primary diagnosis of subarachnoid hemorrhage, intraparenchymal hemorrhage, or stroke and also received HTS (3% or 2%). AKI was defined according to the Acute Kidney Injury Network criteria with hypernatremia defined as a sodium level > 149 mmol/L during the hypertonic saline infusion. Logistic regression was used to evaluate the impact of hypernatremia on the development of AKI and in-hospital mortality, with the Wilcoxon Rank-Sum test used to evaluate the impact of hypernatremia on length of stay. RESULTS: A total of sixty-six patients were included in the analysis of which thirty-six had hypernatremia. In-hospital mortality was higher in patients who developed hypernatremia [38.9% vs. 10%, OR 5.7 (95% CI 1.6, 27.2), p=0.012] as well as AKI [77.8% vs. 36.7%, OR 6.0 (95% CI 2.1, 18.7), p=0.001]. There was no difference in length of stay [15.6 vs. 17.7 days respectively, p=0.74]. CONCLUSIONS: In our retrospective study, the development of hypernatremia during hypertonic saline infusion was associated with greater rates of in-hospital mortality and acute kidney injury. Whether hypertonic saline directly or indirectly leads to acute kidney injury is unclear. Despite this, physicians should be aware of the potential risks associated with hypertonic saline therapy and closely monitor sodium levels. CLINICAL IMPLICATIONS: Prospective studies should be conducted to evaluate the causality of hypertonic saline and acute kidney injury. DISCLOSURES: No relevant relationships by Kristin Fless, source=Web Response No relevant relationships by Patrick Hilden, source=Web Response No relevant relationships by John Hoffman, source=Web Response No relevant relationships by Sasa Ivanovic, source=Web Response No relevant relationships by Aimen Liaqat, source=Web Response No relevant relationships by Nirav Mistry, source=Web Response No relevant relationships by Vagram Ovnanian, source=Web Response No relevant relationships by Fariborz Rezai, source=Web Response No relevant relationships by Paul Yodice, source=Web Response