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

Justin L. Grodin, Jie Lena Sun, Kevin J. Anstrom, Horng Haur Chen, Randall C. Starling, Jeffrey M. Testani, W. H Wilson Tang

Research output: Contribution to journalArticle

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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 postdischarge 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 Renal Optimization Strategies Evaluation in Acute Heart Failure 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 to 98; 99 to 102; and 103 to 117 meq/l. Baseline Cl level was associated with diuretic efficiency (p <0.001) but not change in cystatin C (p = 0.30) at 72 hours and was associated with 60-day death (hazard ratio [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 (ρ 0.18, p = 0.001), cystatin C change (ρ −0.35, p <0.001), and cumulative sodium excretion (ρ −0.21, p <0.001) 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.

Original languageEnglish (US)
Pages (from-to)78-83
Number of pages6
JournalAmerican Journal of Cardiology
Volume119
Issue number1
DOIs
StatePublished - Jan 1 2017

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Chlorides
Homeostasis
Heart Failure
Serum
Diuretics
Sodium Potassium Chloride Symporter Inhibitors
Kidney
Cystatin C
Random Allocation
Hospitalization
Weights and Measures
Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Grodin, J. L., Sun, J. L., Anstrom, K. J., Chen, H. H., Starling, R. C., Testani, J. M., & Tang, W. H. W. (2017). Implications of Serum Chloride Homeostasis in Acute Heart Failure (from ROSE-AHF). American Journal of Cardiology, 119(1), 78-83. https://doi.org/10.1016/j.amjcard.2016.09.014

Implications of Serum Chloride Homeostasis in Acute Heart Failure (from ROSE-AHF). / Grodin, Justin L.; Sun, Jie Lena; Anstrom, Kevin J.; Chen, Horng Haur; Starling, Randall C.; Testani, Jeffrey M.; Tang, W. H Wilson.

In: American Journal of Cardiology, Vol. 119, No. 1, 01.01.2017, p. 78-83.

Research output: Contribution to journalArticle

Grodin, JL, Sun, JL, Anstrom, KJ, Chen, HH, Starling, RC, Testani, JM & Tang, WHW 2017, 'Implications of Serum Chloride Homeostasis in Acute Heart Failure (from ROSE-AHF)', American Journal of Cardiology, vol. 119, no. 1, pp. 78-83. https://doi.org/10.1016/j.amjcard.2016.09.014
Grodin, Justin L. ; Sun, Jie Lena ; Anstrom, Kevin J. ; Chen, Horng Haur ; Starling, Randall C. ; Testani, Jeffrey M. ; Tang, W. H Wilson. / Implications of Serum Chloride Homeostasis in Acute Heart Failure (from ROSE-AHF). In: American Journal of Cardiology. 2017 ; Vol. 119, No. 1. pp. 78-83.
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