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Brain & Heart

REVIEW ARTICLE
Hypochloremia in heart failure: A new

prognostic and therapeutic aspect of refractory
heart failure

Shafaat Raza * and Shahzeen Allah Ditto 2
1
1 Department of Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, Sindh,
Pakistan
2 Department of Nephrology, Liaquat University of Medical and Health Sciences, Jamshoro, Sindh,
Pakistan

Abstract

Heart failure (HF) is one of the most common cardiovascular diseases, bearing
a significant burden of morbidity, mortality, and disability. Low serum chloride
(Cl) levels have been observed to play an important role in predicting mortality
and planning management strategies for HF. This review aims to investigate the
influence of hypochloremia on individuals suffering from HF and its correlation
with various underlying pathophysiological mechanisms. We conducted a literature
review of articles published in the past 10 years, employing specific keywords to
identify relevant studies from databases such as PubMed, Google Scholar, EBSCO,
and Biomed Central. There is a significant paucity of studies relevant to low serum
Cl levels in patients with HF. We found that hypochloremia is commonly observed
in HF cases, an often overlooked aspect in clinical setting, and is associated with
*Corresponding author:
Shafaat Raza poor outcomes. Substantial evidence supports the notion that hypochloremia can
(shafaatraza4@gmail.com) worsen HF, reduce the response to guideline-mediated therapies, and increase
mortality. Hypochloremia activates numerous neurohormonal mechanisms, further
Citation: Raza S, Ditto SA.
Hypochloremia in heart failure: A worsening the cardiorenal circuit in HF. Furthermore, low Cl levels are associated with
new prognostic and therapeutic the development of diuretic resistance, making HF difficult to manage, particularly
aspect of refractory heart failure. with loop diuretics. Studies reveal associations between hypochloremia and various
Brain & Heart. 2024;2(1):2257.
https://doi.org/10.36922/bh.2257 kinases, with a particular emphasis on with-no-lysine kinases. These kinases, involved
in regulating salt and water reabsorption, exacerbate the condition when Cl levels
Received: November 15, 2023
are low. Notably, a low serum Cl level is associated with high mortality in HF and
Accepted: January 12, 2024 worsens the condition. HF with hypochloremia poses challenges in treatment and
Published Online: February 15, should, therefore, be considered in management.
2024
Copyright: © 2024 Author(s). Keywords: Heart failure; Serum chloride; Hypochloremia; Electrolytes; Mortality
This is an Open-Access article
distributed under the terms of the
Creative Commons Attribution
License, permitting distribution,
and reproduction in any medium, 1. Introduction
provided the original work is
properly cited. Heart failure (HF) is the most common cardiovascular disease (CVD), affecting nearly
Publisher’s Note: AccScience 6.2 million adults in the United States. The incidence approaches 21/1000 in individuals
Publishing remains neutral with above 65 years of age. HF is an increasing epidemic, with an approximate prevalence
1
regard to jurisdictional claims in
published maps and institutional of 37.7 million people worldwide. Based on the statistics from the USA, the total cost
affiliations. for individuals with HF has been projected to increase from US$20.9 billion in 2012 to

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