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Brain & Heart Hypochloremia in refractory heart failure

controlled trials (SALTED and SMART) observed the Ethics approval and consent to participate
beneficial effects of balanced solutions over 0.9% saline
in reducing major adverse kidney events (MAKE). They Not applicable.
reported that less critically ill adults developed MAKE in Consent for publication
a balanced solution group compared to those treated with
0.9% saline fluid. 61,62 Not applicable.

9. Conclusion Availability of data
This review explains that serum Cl disturbances, in Not applicable.
particular hypochloremia, are common in patients with References
HF. It also shows that low Cl levels are associated with
mortality, frequent hospitalization, and worsening of HF 1. Lauren T, Joseph R. Advanced heart failure: Epidemiology,
in these patients. There is evidence that only the Na-centric diagnosis, and therapeutic approaches. JACC Heart Fail.
view of electrolytes in HF should not be used in managing 2020;8(7):523-536.
HF populations. We observed that the underlying doi: 10.1016/j.jchf.2020.01.014
pathophysiology of hypochloremia in HF should be 2. Ziaeian B, Fonarow GC. Epidemiology and aetiology of
considered when managing this group of patients. heart failure. Nat Rev Cardiol. 2016;13(6):368-378.
Furthermore, there is a need to look for diuretic resistance
and its potential treatment with agents beyond loop doi: 10.1038/nrcardio.2016.25
diuretics. In instances of hypochloremia and other potential 3. Martinez-Amezcua P, Haque W, Khera R, et al. The
pathways, the administration of loop diuretics can lead to upcoming epidemic of heart failure in South Asia. Circ
the development of diuretic resistance and suboptimal Heart Fail. 2020;13(10):e007218.
outcomes in conditions characterized by excessive fluid doi: 10.1161/CIRCHEARTFAILURE.120.007218
volume. When managing congestive symptoms associated 4. Kurmani S, Squire I. Acute heart failure: Definition,
with HF, it is imperative to explore a range of diuretic classification and epidemiology. Curr Heart Fail
therapeutic options due to the presence of hypochloremia, Rep. 2017;14(5):385-392.
diuretic resistance, and additional electrolyte irregularities. doi: 10.1007/s11897-017-0351-y
Studies have also demonstrated that salt restriction may
cause hypochloremia and worsen this condition. Therefore, 5. Groenewegen A, Rutten FH, Mosterd A, Hoes AW.
it is essential to determine standard levels of Cl in the Epidemiology of heart failure. Eur J Heart Fail.
serum and urine for direct treatment. In addition, further 2020;22(8):1342-1356.
research should be conducted on the possible functions doi: 10.1002/ejhf.1858
of WNKs and alternative pathways as new therapeutic 6. Roger VL. Epidemiology of heart failure: A contemporary
targets. There is a need for large-scale studies, mainly perspective. Circ Res. 2021;128(10):1421-1434.
randomized controlled trials, and studies that focus on doi: 10.1161/CIRCRESAHA.121.318172
dietary interventions to strengthen the evidence of these
results and recommend future practice guidelines. 7. Conrad N, Judge A, Canoy D, et al. Temporal trends
and patterns in mortality after incident heart failure:
Acknowledgments A longitudinal analysis of 86 000 individuals. JAMA Cardiol.
2019;4(11):1102-1111.
None.
doi: 10.1001/jamacardio.2019.3593
Funding 8. Lopuszynski JB, Downing AJ, Finley CM, Zahid M.
None. Prognosticators of all-cause mortality in patients with
heart failure with preserved ejection fraction. Am J Cardiol.
Conflict of interest 2021;158:66-73.
doi: 10.1016/j.amjcard.2021.07.044
The authors declare that they have no competing interests.
9. Tomasoni D, Adamo M, Lombardi CM, Metra M. Highlights
Author contributions in heart failure. ESC Heart Fail. 2019;6(6):1105-1127.
Conceptualization: Shafaat Raza doi: 10.1002/ehf2.12555
Writing—original draft: All Authors 10. Kazory A. Chloride and cardiorenal interactions in heart
Writing—review & editing: All Authors failure. Nephron. 2022;147:6-8.

Volume 2 Issue 1 (2024) 7 https://doi.org/10.36922/bh.2257