Aggressive Fluid and Sodium Restriction in Acute Decompensated Heart Failure

Aliti, Graziella Badin; Rabelo, Eneida Rejane; Clausell, Nadine Oliveira; Rohde, Luís Eduardo Paim; Biolo, Andréia; Beck-da-Silva, Luís

doi:10.1001/jamainternmed.2013.552

Cited by 158 publications

(176 citation statements)

References 25 publications

(29 reference statements)

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“…In all, 751 patients were randomized to either a fluid restriction group (range, 0.8-1.5 L/day) or free fluid intake group (Supplemental Table). 3,4,[6][7][8][9] Two of the trials were conducted in patients with decompensated heart failure. 3,4) Patients with compensated heart failure were evaluated in the other 4 trials.…”

Section: Resultsmentioning

confidence: 99%

“…3,4,[6][7][8][9] Two of the trials were conducted in patients with decompensated heart failure. 3,4) Patients with compensated heart failure were evaluated in the other 4 trials. 6,9) Sodium and fluid were both restricted in two studies, 4,7) and only fluid was restricted in 4 studies.…”

Section: Resultsmentioning

confidence: 99%

“…3,4) Patients with compensated heart failure were evaluated in the other 4 trials. 6,9) Sodium and fluid were both restricted in two studies, 4,7) and only fluid was restricted in 4 studies. 3,6,8,9) The length of follow-up was from 2 weeks to 8 months, with a median follow-up of 10 weeks.…”

Section: Resultsmentioning

confidence: 99%

“…4) The quality of life (QoL) of patients with stabilized heart failure improved during follow-up in the restricted fluid group in one study, 6) and was similar between the groups in two other trials. 7,8) There was no difference between the two groups in post-discharge heart failure, although the sample size was too small to adequately assess this outcome.…”

Section: Subgroup Analysesmentioning

confidence: 96%

“…In fact, recent studies have questioned the benefit of fluid restriction in heart failure patients. 3,4) To synthesize and provide the best possible evidence for application in clinical practice, we conducted a systematic review and meta-analysis of published randomized controlled trials to estimate the effect of fluid restriction in patients with heart failure.…”

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confidence: 99%

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Liberal Versus Restricted Fluid Administration in Heart Failure Patients

Yang

Qian

2015

Int. Heart J.

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SummaryRestrictive fluid intake is recommended, in addition to standard pharmacologic treatment, in the treatment of patients with chronic heart failure (CHF). However, this recommendation lacks firm scientific evidence. We conducted a systematic review and meta-analysis of published randomized controlled trials to estimate the effect of fluid restriction in patients with heart failure.Randomized controlled trials were identified in the MEDLINE, EMBASE, and Cochrane databases using the search-keywords "fluid" and "heart failure". Outcomes were compared in heart failure patients with liberal and restricted fluid intake. Pooled risk ratios (RR) and weighted mean differences (WMD) were calculated using random effects models. Studies focusing on decompensated heart failure were analyzed separately.Six small randomized trials comparing liberal and restricted fluid intake met the inclusion criteria. Significant heterogeneity was noted in the reported studies for several outcomes. There were no differences in readmission rate (5 studies, pooled RR = 1.32; 95% CI: 0.86 to 2.01; P = 0.2), mortality rate (5 studies, pooled RR = 1.50; 95% CI: 0.87 to 2.57; P = 0.14), perceived thirst (4 studies, WMD = -0.7; 95% CI: -2.58 to 1.17; P = 0.46), duration of intravenous diuretics (2 studies, WMD = 0.17; 95% CI: -1.26 to 1.6; P = 0.81) or serum sodium levels (WMD = -1.61; 95% CI: -3.28 to 0.07; P = 0.06) between the liberal fluid intake group and the restrictive fluid intake group. Mean serum creatinine and BNP levels were significantly higher in the liberal fluid group: WMD 0.20 (95% CI: 0.15 to 0.25; P < 0.00001) and 172.59 (95% CI: 67.38 to 277.8; P = 0.001), respectively. There was no difference in any of the outcomes after correcting for heterogeneity.While studies to date are limited by heterogeneity and small sample sizes, the combined data suggest similar clinical outcomes in patients with CHF managed with liberal and restrictive fluid intake. Larger studies are needed to confirm our findings. (Int Heart J 2015; 56: 192-195) Key words: Fluid-resriction, Heart dysfunction, Water-intake I n addition to standard pharmacologic treatment, restrictive fluid intake is often used in the treatment of patients with heart failure. 1,2) While international professional guidelines have recommended fluid restriction for patients with chronic heart failure (CHF), this recommendation lacks firm scientific evidence. This strategy can be stressful to patients and should be supported by better evidence of improved outcomes if it is to be widely used.Prior studies comparing liberal to restricted fluid intake in heart failure patients are limited by small sample sizes, and their individual results do not permit firm conclusions to be drawn. In fact, recent studies have questioned the benefit of fluid restriction in heart failure patients.3,4) To synthesize and provide the best possible evidence for application in clinical practice, we conducted a systematic review and meta-analysis of published randomized controlled trials to estimate the ...

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