Implications of Serum Chloride Homeostasis in Acute Heart Failure (From ROSE-AHF)

• Published in: The American journal of cardiology Vol. 119; no. 1; pp. 78 - 83
• Main Authors: Grodin, Justin L., MD MPH, Sun, Jie-Lena, MS, Anstrom, Kevin J., PhD, Chen, Horng H., MD, Starling, Randall C., MD MPH, Testani, Jeffrey M., MD MTR, Tang, W. H. Wilson, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2017; Elsevier Limited
• Subjects: Aged; Aged, 80 and over; Biomarkers; Biomarkers - blood; Cardiovascular; Chloride; Chlorides - blood; Clinical outcomes; Diuretics; Diuretics - therapeutic use; Dopamine; Efficiency; Female; Heart failure; Heart Failure - blood; Heart Failure - drug therapy; Heart Failure - mortality; Homeostasis; Hospitalization; Humans; Kidney Function Tests; Male; Middle Aged; Mortality; Peptides; Prognosis; Renal Insufficiency - complications; Risk Factors; Rodents; Treatment Outcome; Urine; electrolytes; heart failure; and diuretics
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2016.09.014

Abstract Lower serum chloride (Cl) levels are strongly associated with increased long-term mortality after admission for acute heart failure (AHF). However, the therapeutic implications of serum Cl levels during AHF are unknown. We sought to determine the short-term clinical response and post-discharge outcomes associated with serum Cl levels in AHF. Serum Cl was measured at randomization (N=358) and during hospitalization from patients with AHF in the in the Renal Optimization Strategies Evaluation in Acute Heart Failure (ROSE-AHF) trial. Outcomes included diuretic response and renal function at 72 hours and death and rehospitalization at 60 and 180-days. Baseline Cl tertiles were: 84-98 meq/L; 99-102 meq/L; and 103-117 meq/L. Baseline Cl level was associated with diuretic efficiency (P<.001), but not change in cystatin C (P=0.30) at 72 hours; and was associated with 60-day death (HR 0.86, P=0.029), 60-day death and rehospitalization (HR 0.90, P=0.01), and 180-day death (HR 0.91, P=0.049). These associations were attenuated with additional adjustment for loop diuretic dose (P>0.05). Chloride change correlated with weight change (rho 0.18, P=0.001), cystatin C change (rho -0.35, P<.001), and cumulative sodium excretion (rho -0.21, P<.001), but was not associated with any clinical outcomes (P>0.05 for all). In conclusion, serum Cl levels in AHF were inversely associated with loop diuretic response and were prognostic. However, changes in Cl levels were associated with parameters of decongestion, but not with clinical outcomes.