Low Urinary chlorine at hospitalisation Predicts Poor Outcomes in Acute Heart Failure: Study

Dr. Shravani Dali

Low Urinary chlorine at hospitalisation Predicts Poor Outcomes in Acute Heart Failure: Study

Written By : Dr. Shravani Dali Published On 2026-01-16T22:00:57+05:30 | Updated On 16 Jan 2026 10:01 PM IST

Among hospitalized patients with acute heart failure (AHF), low Urinary chlorine was associated with diuretic resistance, persistent congestion, greater need for aggressive decongestion strategies, worse in-hospital outcomes, and a higher rate of acute heart failure rehospitalisations at 6 months.

The natriuresis measurement is useful to diagnose diuretic resistance (DR) and adjust furosemide doses in acute heart failure (AHF) hospitalized patients, but the utility of urinary chloride is unknown. A study was done to correlate the urine chloride at admission (UCLA) in acute heart failure patients with the development of diuretic resistance and cardiovascular (CV) events at the 180-day outpatient follow-up. A prospective study included patients hospitalized for AHF, without shock, creatinine >2.5 mg/dL or mechanical respiratory support at admission. They received 40 mg of intravenous furosemide at admission, UCLA was measured, and diuretic treatment was based on a protocol. Diuretic resistance was defined as the requirement for furosemide ≥240 mg/day, sequential nephron diuretic blockade (SNB), hypertonic saline serum, or renal replacement therapy.

Results: 116 patients were included, 51% were men, UCLA was 105 meq/L, and diuretic resistance was developed in 17% of patients. The UCLA was associated with the development of DR (p 0.0001; AUC ROC curve 0.81; cut-off point 96 meq/L). UCLA <96 meq/L was associated with persistent congestion (p 0.01), furosemide ≥240 mg/day use (p 0.004), worsening of acute heart failure (p 0.002) and renal function (p 0.02), use of SNB (p 0.001) and inotropic drugs (p 0.007), a longer hospital stay (p 0.02) and a higher CV death (p 0.05). At 180-day follow-up, UCLA <96 meq/L was associated with acute heart failure readmissions (p 0.002).

In acute heart failure hospitalised patients, low UCLA was associated with diuretic resistance , persistent congestion, need for more aggressive decongestion strategies, worse in-hospital clinical outcomes and more acute heart failure hospitalisations at 6 months.

Reference:

Cristhian E. Scatularo, Gardenia Chango Acurio, Luciano Battioni, Analía Guazzone, Hugo O. Grancelli. Urinary chlorine at hospital admission as a predictor of diuretic resistance and clinical evolution in acute heart failure, Current Problems in Cardiology, 2026, 103262, ISSN 0146-2806, https://doi.org/10.1016/j.cpcardiol.2026.103262.

https://www.sciencedirect.com/science/article/pii/S0146280626000058

Keywords:

Low, UCLA, hospitalisation, Predicts, Poor, Outcomes, Acute Heart Failure, Study, Cristhian E. Scatularo, Gardenia Chango Acurio, Luciano Battioni, Analía Guazzone, Hugo O. Grancelli

LowUCLAhospitalisationPredictsPoorOutcomesAcute Heart FailureStudy

Source : Current Problems in Cardiology

Dr. Shravani Dali

Dr. Shravani Dali has completed her BDS from Pravara institute of medical sciences, loni. Following which she extensively worked in the healthcare sector for 2+ years. She has been actively involved in writing blogs in field of health and wellness. Currently she is pursuing her Masters of public health-health administration from Tata institute of social sciences. She can be contacted at editorial@medicaldialogues.in.