Reviews in Cardiovascular Medicine  2020, Vol. 21 Issue (1): 25-29     DOI: 10.31083/j.rcm.2020.01.6 Special Issue: Cardiovascular disorders in chronic kidney disease The dynamic relationship between serum chloride and cardiorenal syndrome Amir Kazory1, *(), Maria Rosa Costanzo2 1 Division of Nephrology, Hypertension, and Renal Transplantation, University of Florida, Gainesville, Florida 32610, USA
2 Advocate Heart Institute, Naperville, Illinois 60540, USA Abstract:

Low serum sodium concentration has long been recognized as an established marker of short- and long-term morbidity and mortality in patients with heart failure (HF), and is commonly included in various risk prediction models. Mechanisms leading to hyponatremia (e.g. maladaptive neurohormonal activation) could also lead to concurrent decline in serum chloride levels. Besides, chloride has distinct biological roles (e.g. modulation of renal tubular sodium transporters) that are relevant to the pathophysiology and therapy of HF, making it a potent cardiorenal connector. Several clinical studies have recently reported on a potentially overlooked link between low serum chloride levels and adverse outcomes in patients with a wide variety of HF syndromes, which could indeed be stronger than that of sodium. While evidence on predictive value of chloride is accumulating in various patient populations and settings, the limited available interventional studies have so far yielded conflicting results. It remains to be elucidated whether hypochloremia represents a marker of disease severity and prognosis, or it is an actual pathogenetic mechanism, hence being a potential novel target of therapy. Current ongoing studies are designed to better understand the mechanistic aspects of the role of hypochloremia in HF and shed light on its clinical applicability.

Submitted:  27 January 2020      Accepted:  25 March 2020      Published:  30 March 2020      *Corresponding Author(s):  Amir Kazory     E-mail:  Amir.Kazory@medicine.ufl.edu Service E-mail this article Add to citation manager E-mail Alert RSS Articles by authors Amir Kazory    Maria Rosa Costanzo    [1] Adkins, G. B. and Curtis, M. J. (2015)Potential role of cardiac chloride channels and transporters as novel therapeutic targets.Pharmacology & Therapeutics 145, 67-75. [2] Berend, K.,van Hulsteijn, L. H, andGans, R. O. (2012)Chloride: the queen of electrolytes?European Journal of Internal Medicine 23, 203-211. [3] Clemo, H. F.,Feher, J. J. and Baumgarten, C. M. (1992)Modulation of rabbit ventricular cell volume and Na+/K+/2Cl-cotransport by cGMP and atrial natriuretic factor.The Journal of General Physiology 100, 89-114. [4] Cuthbert, J. J.,Pellicori, P.,Rigby, A.,Pan, D.,Kazmi, S.,Shah, P. and Clark, A. L. 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