The Role of Hypochloremia in Heart Failure Progression

Electrolyte derangements are common in dogs and cats with congestive heart failure, both before and after diuretic therapy. The importance of hypochloremia in this clinical setting has only recently been recognized in veterinary medicine. Hypochloremia appears to be a marker of disease severity but it also contributes to disease progression, regardless of whether it is caused by dilution or loop diuretic-induced depletion. Acknowledging the role of hypochloremia in promoting neurohormonal activation and diuretic resistance begs the question of whether raising serum chloride concentrations can positively impact patient outcomes. This session will review renal chloride handling, the impact of loop diuretics on chloride homeostasis and tubuloglomerular feedback, the impact of co-existent metabolic alkalosis, and strategies to overcome both dilutional and depletional hypochloremia of heart failure.