Division of Nephrology, Hypertension, and Renal Transplantation, University of Florida, Gainesville, Florida, USA,
Department of Nephrology, San Bortolo Hospital and International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy.
Blood Purif. 2020;49(1-2):219-221. doi: 10.1159/000503774. Epub 2019 Dec 18.
Several studies have recently challenged the sodium-centric view that has been dominating the field of heart failure (HF) and cardiorenal syndrome. The previously observed benefits of severe dietary restriction of salt do not seem to be consistently reproduced by contemporary studies. Moreover, there is evidence that too low intake may paradoxically lead to adverse outcomes in more advanced stages of HF. Facing the escalating controversy, investigators have shifted their focus from sodium to its often overlooked counter ion in salt, the chloride. Emerging data suggest that serum chloride levels could portend robust independent prognostic value in a wide range of HF syndromes possibly stronger than that of sodium. The untoward impact of hypochloremia on the outcomes could be mechanistically linked to renal tubular regulatory pathways, neurohormonal activation, and diuretic resistance. As such, it can be a potential target of therapy in this setting. In this article, the authors provide a brief overview of the role of serum chloride as a cardiorenal connector and explore the context in which the contemporary data should be interpreted. Implementation of predictive and therapeutic strategies incorporating the emerging evidence would be refined through discussion of nuances of such findings as well as their biological and clinical relevance.
最近有几项研究对主导心力衰竭 (HF) 和心肾综合征领域的钠中心观点提出了挑战。以前观察到的严重限制盐摄入的益处似乎并没有被当代研究一致再现。此外，有证据表明，摄入过低可能会在 HF 的更晚期阶段反常地导致不良后果。面对不断升级的争议，研究人员将注意力从钠转移到盐中经常被忽视的反离子——氯离子。新出现的数据表明，血清氯水平可能在广泛的 HF 综合征中预示着强大的独立预后价值，其强度可能超过钠。低氯血症对结局的不利影响可能与肾小管调节途径、神经激素激活和利尿剂抵抗在机制上有关。因此，它可能成为该环境下治疗的潜在靶点。在本文中，作者简要概述了血清氯作为心肾连接物的作用，并探讨了应如何解释当代数据的背景。通过讨论这些发现的细微差别及其生物学和临床相关性，可以完善纳入新出现证据的预测和治疗策略的实施。
