Abstract: FR-PO1155
Serum Chloride and Mortality in Cardiovascular-Kidney-Metabolic Syndrome
Session Information
- CKD: Screening, Diagnosis, Serum and Urine Biomarkers, and Scoring Indices
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Author
- Lin, Wenjun, Department of Nephrology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
Background
Serum chloride, though routinely measured, remains an underexplored marker of risk in individuals with cardiovascular-kidney-metabolic (CKM) syndrome.
Methods
We analyzed data from 32,259 adults with CKM syndrome (stages 1–4) participating in the National Health and Nutrition Examination Survey (1999–2018). Associations between baseline serum chloride levels and all-cause, cardiovascular, and non-cardiovascular mortality were assessed using restricted cubic spline models and Cox proportional hazards regression. We also examined the joint impact of serum chloride and CKM stage on mortality risk.
Results
Over a median follow-up of 107.0 months, 5,641 participants died, including 1,557 from cardiovascular causes. Serum chloride showed a U-shaped association with all mortality outcomes, with the lowest risk observed near 104.5 mmol/L. Markedly low chloride levels (<96.5 mmol/L) were associated with the highest all-cause mortality (HR, 2.21; 95% CI, 1.91–2.56). The association became progressively stronger with advancing CKM stage; in stage 4 CKM, hypochloremia (<100.4 mmol/L) conferred a four-fold increase in all-cause mortality (HR, 4.01; 95% CI, 3.09–5.20) and a nearly seven-fold increase in cardiovascular mortality. These U-shaped relationships remained consistent across sensitivity and subgroup analyses, with more pronounced inverse associations in participants aged <65 years and those with chloride <=104.5 mmol/L.
Conclusion
In adults with CKM syndrome, serum chloride was independently associated with mortality in a U-shaped manner. These findings position serum chloride as a simple yet informative biomarker that may enhance risk stratification in this vulnerable population.