Comment: Assessment of Acute Kidney Injury in Neurologically Injured Patients Receiving Hypertonic Sodium Chloride: Does Chloride Load Matter?

Reply: Assessment of Acute Kidney Injury in Neurologically Injured Patients Receiving Hypertonic Sodium Chloride: Does Chloride Load Matter?

“…We do believe that it is difficult to compare this neurologically injured population with populations in previously published studies mentioned by Gueret et al, 1 because these studies were not performed in the neurologically injured patient population. We believe that this patient population likely has a higher risk of AKI secondary to hyperchloremia because of the necessity of treating their neurological illness with hypernatremic fluids; however, this has been difficult to demonstrate in the study environment.…”

“…We thank Gueret et al 1 for their comments on our recent article and acknowledge that we too understand that our retrospective study cannot answer all the issues regarding acute kidney injury (AKI) caused by hyperchloremia in the neurologically injured patient population. 1,2 The question posed regarding the risk of AKI in the neurologically injured population only stimulates more questions and research opportunities. We chose to use the acute kidney injury network (AKIN) criteria based on a previous study assessing AKI caused by hyperchloremia in a similar patient population.…”

“…We thank Gueret et al 1 for their comments on our recent article and acknowledge that we too understand that our retrospective study cannot answer all the issues regarding acute kidney injury (AKI) caused by hyperchloremia in the neurologically injured patient population. 1,2…”

“…However, as mentioned, the AKI group was small and had a wide SD. Given this information, Gueret et al 1 have recommended a nonparametric test to evaluate these 2 groups. 1 Therefore, we ran a Mann-Whitney U test and found a statistical difference between the baseline SCr of the 2 groups, with a z -score of −3.08 and a P value of 0.002.…”

“…Given this information, Gueret et al 1 have recommended a nonparametric test to evaluate these 2 groups. 1 Therefore, we ran a Mann-Whitney U test and found a statistical difference between the baseline SCr of the 2 groups, with a z -score of −3.08 and a P value of 0.002. We do note this statistical difference when running this particular test; however, it should be noted that the data distribution was approximately normal (meaning the Student t -test was appropriate) and the clinical difference of these 2 means is unknown (AKI group 1.33 ± 0.91 and no AKI group 0.98 ± 1.67).…”