Division of Nephrology, Hypertension, and Renal Transplantation, University of Florida, Gainesville, Florida 32610, USA.
Advocate Heart Institute, Naperville, Illinois 60540, USA.
Rev Cardiovasc Med. 2020 Mar 30;21(1):25-29. doi: 10.31083/j.rcm.2020.01.6.
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.
血清钠浓度降低长期以来一直被认为是心力衰竭（HF）患者短期和长期发病率和死亡率的既定标志物，并且通常包含在各种风险预测模型中。导致低钠血症的机制（例如，适应性神经激素激活）也可能导致血清氯水平同时下降。此外，氯具有独特的生物学作用（例如，调节肾小管钠转运体），与 HF 的病理生理学和治疗相关，使其成为强有力的心肾连接物。最近有几项临床研究报告了低血清氯水平与各种 HF 综合征患者不良结局之间可能被忽视的联系，其相关性实际上比钠更强。虽然氯的预测价值证据在各种患者人群和环境中不断积累，但迄今为止有限的干预性研究得出了相互矛盾的结果。低氯血症是否代表疾病严重程度和预后的标志物，或者它是否是一种实际的发病机制，因此是否是治疗的潜在新靶点，仍有待阐明。目前正在进行的研究旨在更好地了解低氯血症在 HF 中的作用的机制方面，并阐明其临床适用性。
