Aggressive Fluid and Sodium Restriction in Acute Decompensated Heart Failure: A Randomized Clinical Trial
Open accessAbstract
Importance The benefits of fluid and sodium restriction in patients hospitalized with acute decompensated heart failure (ADHF) are unclear. Objective To compare the effects of a fluid-restricted (maximum fluid intake, 800 mL/d) and sodium-restricted (maximum dietary intake, 800 mg/d) diet (intervention group [IG]) vs a diet with no such restrictions (control group [CG]) on weight loss and clinical stability during a 3-day period in patients hospitalized with ADHF. Design Randomized, parallel-group clinical trial with blinded outcome assessments. Setting Emergency room, wards, and intensive care unit. Participants Adult inpatients with ADHF, systolic dysfunction, and a length of stay of 36 hours or less. Intervention Fluid restriction (maximum fluid intake, 800 mL/d) and additional sodium restriction (maximum dietary intake, 800 mg/d) were carried out until the seventh hospital day or, in patients whose length of stay was less than 7 days, until discharge. The CG received a standard hospital diet, with liberal fluid and sodium intake. Main outcomes and measures Weight loss and clinical stability at 3-day assessment, daily perception of thirst, and readmissions within 30 days. Results Seventy-five patients were enrolled (IG, 38; CG, 37). Most were male; ischemic heart disease was the predominant cause of heart failure (17 patients [23%]), and the mean (SD) left ventricular ejection fraction was 26% (8.7%). The groups were homogeneous in terms of baseline characteristics. Weight…
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In an RCT of 410 compensated chronic heart failure patients, the group consuming a normal-sodium diet (120 mmol sodium) showed significant reductions in readmissions, brain natriuretic peptide, aldosterone, and plasma renin activity compared with groups consuming lower sodium dosages.
“The group consuming the normal-sodium diet (120 mmol sodium) showed the best results, with”
From ESPEN guideline on hospital nutrition (2021) · cites this paper as [159]
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2013 ACCF/AHA Guideline for the Management of Heart Failure
Yancy, C. W., Jessup, M., Bozkurt, B., Butler, J., Casey, D. E., Drazner, M. H., Fonarow, G. C., Geraci, S. A., Horwich, T., Januzzi, J. L., et al. (2013) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2013.05.019 · Cited by 12,536 · see citing works
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2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure
Heidenreich, P. A., Bozkurt, B., Aguilar, D., Allen, L. A., Byun, J. J., Colvin, M. M., Deswal, A., Drazner, M. H., Dunlay, S. M., Evers, L. R., et al. (2022) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2021.12.012 · Cited by 2,862 · see citing works
Heidenreich, P. A., Bozkurt, B., Aguilar, D., Allen, L. A., Byun, J. J., Colvin, M. M., Deswal, A., Drazner, M. H., Dunlay, S. M., Evers, L. R., et al. (2022) · Circulation · doi:10.1161/cir.0000000000001063 · Cited by 4,922 · see citing works
Ezekowitz, J. A., O'Meara, E., McDonald, M. A., Abrams, H., Chan, M., Ducharme, A., Giannetti, N., Grzeslo, A., Hamilton, P. G., Heckman, G. A., et al. (2017) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2017.08.022 · Cited by 676 · see citing works
ESPEN guideline on hospital nutrition
Thibault, R., Abbasoglu, O., Ioannou, E., Meija, L., Ottens-Oussoren, K., Pichard, C., Rothenberg, E., Rubin, D., Siljamäki-Ojansuu, U., Vaillant, M.-F., et al. (2021) · Clinical Nutrition · doi:10.1016/j.clnu.2021.09.039 · Cited by 259 · see citing works
Lifestyle modifications for preventing and treating heart failure
Aggarwal, M., Bozkurt, B., Panjrath, G., Aggarwal, B., Ostfeld, R. J., Barnard, N. D., Gaggin, H., Freeman, A. M., Allen, K., Madan, S., et al. (2018) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2018.08.2160 · Cited by 162 · see citing works
The role of diet and nutrition in heart failure: A state-of-the-art narrative review
Billingsley, H. E., Hummel, S. L., & Carbone, S. (2020) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2020.08.004 · Cited by 106 · see citing works
- Authors
- Aliti, G. B., Rabelo, E. R., Clausell, N., Rohde, L. E., Biolo, A., & Beck-da-Silva, L.
- Affiliations
- Universidade Federal do Rio Grande do Sul (BR)
- Venue
- JAMA Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2013-06-24
- Volume
- 173
- Issue
- 12
- Pages
- 1058
- ISSN
- 2168-6106 (ISSN-L)
- OpenAlex
- W2020503327
- Cited by
- 187
- References
- 1
- Citations by year
- 2026: 10 · 2025: 13 · 2024: 13 · 2023: 8 · 2022: 14 · 2021: 20 · 2020: 15 · 2019: 9 · 2018: 9 · 2017: 12 · 2016: 11 · 2015: 20 · 2014: 21 · 2013: 12
- FWCI
- 14.51
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Licence
- other-oa
- Locations
- JAMA Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Americanae (AECID Library) (publishedVersion, other-oa)
- LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (submittedVersion, cc-by-nc-sa)
- Lume (Universidade Federal do Rio Grande do Sul) (submittedVersion, other-oa)
- Funders
- Hospital de Clínicas de Porto Alegre
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Electrolyte and hormonal disorders
- Health Sciences › Nursing › Nutrition and Dietetics › Sodium Intake and Health
- Keywords
- acute decompensated heart failure, fluid restriction, sodium restriction, weight loss, thirst, hospital readmission, systolic dysfunction, dietary intervention, length of hospital stay, emergency department admission, intensive care unit admission, diuretic therapy
- MeSH terms
- Acute Disease, Aged, Diet, Sodium-Restricted, Double-Blind Method, Female, Follow-Up Studies, Heart Failure, Humans, Inpatients, Length of Stay, Male, Middle Aged, Risk Factors, Thirst, Biomarkers, Weight Loss, Case-Control Studies, Treatment Outcome, Risk Assessment, Natriuretic Peptide, Brain, Drinking Water
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