Risk of death and cardiovascular hospitalizations increases as serum chloride levels decrease. A restricted cubic spline curve with four knots showing the association of serum chloride levels with hazard ratio (solid line) and 95% confidence interval (dotted line). Model is adjusted for age, sex, body mass index, systolic blood pressure, diabetes mellitus, past hospitalizations due to cardiovascular diseases, estimated glomerular filtration rate, hemoglobin, albumin, calcium, phosphate, sodium, bicarbonate levels and medication dose (loop and thiazide diuretics, spironolactone and sodium bicarbonate). The reference value of chloride is 107 mEq/L.