Chloride in Heart Failure: The Neglected Electrolyte

Arietje J L Zandijk; Margje R van Norel; Florine E C Julius; Nariman Sepehrvand; Neesh Pannu; Finlay A McAlister; Adriaan A Voors; Justin A Ezekowitz

doi:10.1016/j.jchf.2021.07.006

Chloride in Heart Failure: The Neglected Electrolyte

JACC Heart Fail. 2021 Dec;9(12):904-915. doi: 10.1016/j.jchf.2021.07.006. Epub 2021 Oct 6.

Authors

Arietje J L Zandijk¹, Margje R van Norel¹, Florine E C Julius¹, Nariman Sepehrvand², Neesh Pannu³, Finlay A McAlister⁴, Adriaan A Voors⁵, Justin A Ezekowitz⁶

Affiliations

¹ Department of Medicine, University Medical Center Groningen, Groningen, the Netherlands.
² Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada; Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
³ Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
⁴ Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada; Division of General Internal Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
⁵ Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
⁶ Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada; Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. Electronic address: jae2@ualberta.ca.

PMID: 34857174
DOI: 10.1016/j.jchf.2021.07.006

Abstract

The increasing burden of heart failure (HF) and emerging knowledge regarding chloride as a prognostic marker in HF have increased the interest in the pathophysiology and interactions of chloride abnormalities with HF-related factors and treatments. Chloride is among the major electrolytes that play a unique role in fluid homeostasis and is associated with cardiorenal and neurohormonal systems. This review elucidates the role of chloride in the pathophysiology of HF, evaluates the effects of treatment on chloride (eg, diuretic agents cause higher urinary chloride excretion and consequently serum hypochloremia), and discusses recent evidence for the association between chloride levels and mortality.

Keywords: chloride; heart failure; hypochloremia; outcome; pathophysiology; prognosis; treatment.

Publication types

Review

MeSH terms

Chlorides
Diuretics / therapeutic use
Electrolytes
Heart Failure*
Humans
Water-Electrolyte Imbalance*

Substances

Chlorides
Diuretics
Electrolytes