Skip to main content

Research Repository

Advanced Search

Hypochloraemia in Patients with Heart Failure: Causes and Consequences

Cuthbert, Joseph J.; Bhandari, Sunil; Clark, Andrew L.

Authors

Sunil Bhandari

Andrew L. Clark



Abstract

Hypochloraemia is a common electrolyte abnormality in patients with heart failure (HF). It has a strong association with adverse outcome regardless of HF phenotype and independent of other prognostic markers. How hypochloraemia develops in a patient with HF and how it might influence outcome are not clear, and in this review we explore the possible mechanisms. Patients with HF and hypochloraemia almost invariably take higher doses of loop diuretic than patients with normal chloride levels. However, renal chloride and bicarbonate homeostasis are closely linked, and the latter may be influenced by neurohormonal activation: it is likely that the etiology of hypochloraemia in patients with HF is multifactorial and due to more than just diuretic-induced urinary losses. There are multiple proposed mechanisms by which low chloride concentrations may lead to an adverse outcome in patients with HF: by increasing renin release; by a stimulatory effect on the with-no-lysine kinases which might increase renal sodium-chloride co-transporter activity; and by an adverse effect on myocardial conduction and contractility. None of these proposed mechanisms are proven in humans with HF. However, if true, it might suggest that hypochloraemia is a therapeutic target that might be amenable to treatment with acetazolamide or chloride supplementation.

Citation

Cuthbert, J. J., Bhandari, S., & Clark, A. L. (2020). Hypochloraemia in Patients with Heart Failure: Causes and Consequences. Cardiology and Therapy, 9(2), 333-347. https://doi.org/10.1007/s40119-020-00194-3

Journal Article Type Review
Online Publication Date Aug 9, 2020
Publication Date Dec 1, 2020
Deposit Date Jun 8, 2022
Publicly Available Date Oct 24, 2024
Journal Cardiology and Therapy
Print ISSN 2193-8261
Peer Reviewed Peer Reviewed
Volume 9
Issue 2
Pages 333-347
DOI https://doi.org/10.1007/s40119-020-00194-3
Keywords Acetazolamide; Chloride; Diuretics; Diuretic resistance; Heart failure; Hypochloraemia; Metabolic alkalosis; Outcome; Prognosis; Sudden death
Public URL https://hull-repository.worktribe.com/output/3557874

Files

Published article (1.1 Mb)
PDF

Publisher Licence URL
http://creativecommons.org/licenses/by-nc/4.0

Copyright Statement
© The Author(s) 2020.
Open Access This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/.





You might also like



Downloadable Citations