Effect of renal function on the prognostic importance of chloride in patients with heart failure

Author:

Çetin Güvenç Rengin1,Güvenç Tolga Sinan2,Temizhan Ahmet3,Çavuşuğlu Yüksel4,Çelik Ahmet5,Yılmaz Mehmet Birhan6

Affiliation:

1. Division of Cardiology, Department of Internal Medical Sciences, School of Medicine, Istanbul Okan University, Istanbul, Turkey

2. Division of Cardiology, Department of Internal Medical Sciences, School of Medicine, Istinye University, Istanbul, Turkey

3. Department of Cardiology, Ankara City Hospital, Ankara, Turkey

4. Division of Cardiology, Department of Internal Medical Sciences, School of Medicine, Eskisehir Osmangazi University, Istanbul, Turkey

5. Division of Cardiology, Department of Internal Medical Sciences, School of Medicine, Mersin University, Istanbul, Turkey

6. Division of Cardiology, Department of Internal Medical Sciences, School of Medicine, Dokuz Eylul University, Istanbul, Turkey

Abstract

Hypochloremia has recently gained interest as a potential marker of outcomes in patients with heart failure (HF). The exact pathophysiologic mechanism linking hypochloremia to HF is unclear but is thought to be mediated by chloride-sensitive proteins and channels located in kidneys. This analysis aimed to understand whether renal dysfunction (RD) affects the association of hypochloremia with mortality in patients with HF. Using data from a nationwide registry, 438 cases with complete data on serum chloride concentration and 1-year survival were included in the analysis. Patients with an estimated glomerular filtration rate of <60 mL/min/m2 at baseline were accepted as having RD. Hypochloremia was defined as a chloride concentration <96 mEq/L at baseline. For HF patients without RD at baseline, patients with hypochloremia had a significantly higher 1-year all-cause mortality than those without hypochloremia (41.6% vs 13.0%, log-rank p < 0.001) and the association remained significant after multivariate adjustment (odds ratio (OR): 2.55, 95% confidence interval (CI): 1.25–5.21). The evidence supporting the association was very strong in this subgroup (Bayesian Factor (BF)10: 48.25, log OR: 1.56, 95% CI: 0.69–2.43). For patients with RD at baseline, there was no statistically significant difference for 1-year mortality for patients with or without hypochloremia (36.3% vs 29.7, log-rank p = 0.35) and there was no evidence to support an association between hypochloremia and mortality (BF10: 1.18, log OR :0.66, 95% CI: −0.02 to 1.35). In patients with HF, the association between low chloride concentration and mortality is limited to those without RD at baseline.

Publisher

SAGE Publications

Subject

General Biochemistry, Genetics and Molecular Biology,General Medicine

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