Abstract: TH-PO0758
Urinary Sodium-Chloride Dissociation Identifies Persistent Kidney Dysfunction in Cardiorenal Syndrome
Session Information
- AKI: Critical Care, CKRT, Cardiorenal Syndromes, and Clinical Outcomes
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Bastida Castro, Luis Angel, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Mexico
- Garza Romero, Maria Fernanda, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Mexico
- Pech Cruz, Julio Ismael, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Mexico
- Gomez Johnson, Victor Hugo, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Mexico
Background
Urinary sodium (NaU) is commonly used to assess diuretic response in acute heart failure but may inadequately reflect renal recovery in cardiorenal syndrome (CRS). Chloride regulates macula densa signaling and neurohormonal activation, suggesting urinary chloride (ClU) may better identify maladaptive tubular states. We evaluated the association of ClU and sodium-chloride dissociation (NaU−ClU) with renal outcomes in CRS.
Methods
Prospective observational cohort of 41 patients hospitalized with acute decompensated heart failure and CRS1. Spot urinary electrolytes at admission included NaU, ClU, and NaU−ClU. A Chloride Depletion Score (SDCl) was developed using ClU ≤26.7 mmol/L and NaU > ClU.
Primary outcome was persistent renal dysfunction (ΔCr >0.3 mg/dL from baseline at discharge). ROC analysis, logistic regression, and K-means clustering were performed.
Results
NaU poorly predicted persistent renal dysfunction (AUC 0.52), while NaU−ClU and SDCl showed better performance (AUC 0.69). Higher NaU−ClU correlated with lower discharge eGFR (ρ=-0.345, p=0.027).
SDCl ≥1 was associated with higher persistent renal dysfunction (55% vs 16%; OR 6.4, p=0.021) and remained significant after adjustment (adjusted OR≈10; AUC 0.81).
Urinary chloride and NaU−ClU differentiated risk groups, whereas NaU did not (p=0.7). Cluster analysis suggested a U-shaped relationship between urinary electrolyte excretion and renal outcomes.
Conclusion
Urinary sodium poorly predicts renal recovery in CRS. Urinary chloride and sodium-chloride dissociation identify a chloride-depletion phenotype associated with persistent renal dysfunction and may improve early risk stratification.
Acknowledgment
The authors acknowledge the Department of Nephrology at the National Institute of Cardiology Ignacio Chávez for support in patient care, data collection, and clinical analysis.