Perioperative hyperchloremia is associated with acute kidney injury in elderly patients undergoing bipolar plasmakinetic transurethral resection of the prostate: a prospective observational study.

BACKGROUND

Bipolar transurethral resection of the prostate (TURP) utilizes 0.9% saline irrigation, which eliminates the risk of traditional TUR syndrome (hyponatremia) but may cause hyperchloremia due to absorption of supraphysiological chloride fluid. The incidence of hyperchloremia and its association with acute kidney injury (AKI) in this context remain poorly defined.

METHODS

In this prospective observational study, 614 patients undergoing bipolar plasmakinetic TURP were categorized into Hyperchloremia (postoperative peak chloride ≥ 110 mmol/L) and Non-Hyperchloremia groups. The primary outcome was the incidence of postoperative AKI, defined according to KDIGO creatinine criteria. Secondary outcomes included AKI severity, clinical outcomes, and the association between hyperchloremia and a composite adverse outcome (ICU admission, mechanical ventilation, or renal replacement therapy).

RESULTS

Postoperative plasma chloride levels were positively correlated with the volume of irrigation fluid absorbed (R² = 0.6839, P < 0.001), and hyperchloremia occurred in 70 patients (11.4%). The Hyperchloremia Group had a significantly higher AKI incidence (30.0% vs. 5.1%, P < 0.001) and greater AKI severity (Stage 1: 15.7% vs. 4.4%; Stage 2: 10.0% vs. 0.7%; Stage 3: 4.3% vs. 0%; all P < 0.05) than the Non-Hyperchloremia Group. A strong dose-response relationship was observed between peak chloride levels and AKI severity (Spearman's ρ = 0.519, P < 0.001). Hyperchloremia was independently associated with the composite adverse outcome, even after adjusting for AKI and other confounders (fully adjusted OR 6.24; 95% CI 1.29-30.00; P = 0.022).

CONCLUSIONS

Hyperchloremia is a common and serious complication resulting from absorption of irrigation fluid during bipolar TURP. It is strongly associated with an increased incidence and severity of AKI and is an independent risk factor for major adverse outcomes. These findings advocate for perioperative chloride monitoring and further investigation of balanced irrigation fluids to improve patient safety.

TRIAL REGISTRATION

www.chictr.org.cn ; identifier: ChiCTR2300079095; Date: December 25, 2023.

© 2026. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.