Division of Nephrology, Hypertension, and Renal Transplantation, University of Florida, Gainesville, Florida, USA.
Nephron. 2023;147(1):6-8. doi: 10.1159/000524987. Epub 2022 May 31.
The cardiorenal literature has long been dominated by a sodium-centric view. However, mechanisms affecting sodium homeostasis in patients with heart failure (HF) commonly lead to concurrent changes in the serum levels of chloride as well. There is a growing body of evidence on a strong link between low serum chloride levels and adverse outcomes in HF, which might be even more potent than that of sodium. Maladaptive neurohormonal activation and unresponsiveness to diuretics have been proposed as potential mechanisms to explain this phenomenon. In parallel with accumulating evidence on the predictive value of chloride in various HF populations, the limited available interventional studies that were aimed at increasing serum chloride levels have also shown promising results. Ongoing studies are designed to elucidate the role of chloride as a key cardiorenal connector and whether hypochloremia represents a modifiable risk factor (i.e., target of therapy) or a mere marker of disease severity and poor prognosis.
心脏肾文献长期以来一直以钠为中心。然而，影响心力衰竭（HF）患者钠平衡的机制通常也会导致血清氯水平的同步变化。越来越多的证据表明，低血清氯水平与 HF 的不良预后之间存在很强的关联，其关联强度甚至超过钠。适应性神经激素激活和对利尿剂不敏感被认为是解释这一现象的潜在机制。随着氯离子在各种 HF 人群中的预测价值的累积证据，旨在提高血清氯离子水平的有限的干预研究也取得了有希望的结果。正在进行的研究旨在阐明氯离子作为心脏肾连接的关键作用，以及低氯血症是否代表可改变的风险因素（即治疗目标），还是仅仅是疾病严重程度和预后不良的标志。
