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Cited by 46Heart Failure Treatment and ManagementElectrolyte and hormonal disordersCardiovascular and exercise physiology

Liberal fluid intake versus fluid restriction in chronic heart failure: a randomized clinical trial

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Herrmann, Job J., Brunner-La Rocca, Hans-Peter, Baltussen, Lisette E. H. J. M., Beckers-Wesche, Fabienne, Bekkers, Sebastiaan C. A. M., Bellersen, Louise, van Eck, J. W. Martijn, Hassing, H. Carlijne +14 more·2025·Nature Medicine
DOI 10.1038/s41591-025-03628-4
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Abstract

Fluid restriction is frequently recommended to patients with chronic heart failure, but randomized clinical trials assessing the effects of fluid restriction remain scarce. In this multicenter open-label trial, outpatients with chronic heart failure were randomized to receiving advice for liberal fluid intake versus receiving advice for fluid restriction, up to 1,500 ml per day of fluid intake. The primary outcome of the trial was health status after 3 months, as assessed by the Kansas City Cardiomyopathy Questionnaire Overall Summary Score (KCCQ-OSS). Secondary outcomes included thirst distress and safety events. Among 504 randomized patients (67.3% male), the KCCQ-OSS after 3 months was 74.0 in the liberal fluid intake group versus 72.2 in the fluid restriction group, with a mean difference after adjustment for baseline scores of 2.17 (95% confidence interval -0.06 to 4.39; P = 0.06), indicating that the primary outcome was not met. Thirst distress was higher in the fluid restriction group and no differences were observed for safety events between the two groups. These findings question the benefit of fluid restriction in chronic heart failure. ClinicalTrials.gov registration: NCT04551729 .

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Authors
Herrmann, J. J., Brunner-La Rocca, H.-P., Baltussen, L. E. H. J. M., Beckers-Wesche, F., Bekkers, S. C. A. M., Bellersen, L., van Eck, J. W. M., Hassing, H. C., Jaarsma, T., Linssen, G. C. M., Pisters, R., Sanders-van Wijk, S., Verdijk, M. H. I., Handoko, M. L., van der Meer, P., Verbrugge, F. H., Januzzi, J. L., Bayés-Genís, A., Nieuwlaat, R., Rodwell, L., Gommans, D. H. F., & van Kimmenade, R. R. J.
Affiliations
  • Radboud University Medical Center (NL)
  • Ziekenhuis Bernhoven (NL)
  • Linköping University (SE)
  • Ziekenhuis Groep Twente (NL)
  • Rijnstate Hospital (NL)
  • University Medical Center Utrecht (NL)
  • Vrije Universiteit Brussel (BE)
  • Harvard University (US)
  • McMaster University (CA)
ORCID
Venue
Nature Medicine
Publisher
Springer Science and Business Media LLC
Published
2025-03-30
Volume
31
Issue
6
Pages
2062-2068
ISSN
  • 1078-8956 (ISSN-L)
  • 1546-170X
DOI
10.1038/s41591-025-03628-4
OpenAlex
W4408973755
Cited by
46
References
29
Citations by year
2026: 25 · 2025: 21
FWCI
32.14
Type
journal article
Language
en
Open access
Licence
Locations
  • Nature Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • KTH Publication Database DiVA (KTH Royal Institute of Technology) (submittedVersion, other-oa)
  • Radboud Repository (Radboud University) (submittedVersion)
  • Research Publications (Maastricht University) (submittedVersion, other-oa)
  • Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
  • University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, other-oa)
  • VUBIR (Vrije Universiteit Brussel) (submittedVersion)
Funders
  • Pfizer
  • ZonMw
  • Radboud Universiteit
  • Universiteit Maastricht
  • Hartstichting (2019T100)
  • Novo Nordisk
  • Maastricht Universitair Medisch Centrum
  • Radboud Universitair Medisch Centrum
  • Vifor Pharma
  • Netherlands Heart Institute
  • Daiichi Sankyo Europe
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 › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
Keywords
chronic heart failure, fluid restriction, health status, Kansas City Cardiomyopathy Questionnaire, patient-reported outcomes, outpatient management, safety incidents
MeSH terms
Aged, Chronic Disease, Drinking, Female, Heart Failure, Humans, Male, Middle Aged, Thirst, Treatment Outcome

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