Chloride as an Overlooked Cardiorenal Link in Heart Failure

Emerging data suggest that serum chloride levels could portend robust independent prognostic value in a wide range of HF syndromes possibly comparable and linked to 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 [1]. Over the last decades, a core recommendation in management of HF has been dietary modifications focusing on lower salt intake. However, more recent evidence has challenged the conventional sodium-centric view suggesting that higher salt intake may be without untoward consequences, and too low intake may paradoxically lead to adverse outcomes [2]. Some investigators have even used hypertonic saline solution to successfully treat acute HF [3]. Facing the escalating controversy, there have been calls for “a retreat from an unbridled and potentially harmful insistence on rigorous sodium restriction in those with symptomatic HF”.