Aggressive Fluid and Sodium Restriction in Acute Decompensated Heart Failure

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The objective of this study was to determine if the effects of an aggressive fluid-restricted and sodium-restricted diet differed from the effects with no such restrictions on weight loss and clinical stability throughout a three day period in hospitalized patients with acute decompensated heart failure (ADHF). Sodium and fluid restrictions are therapeutic remedies that have been used to treat ADHF universally. However, there is a lack of evidence based research to conclude that there is improvement to reach clinical stability in patients with ADHF.

A total of 813 patients admitted with ADHF were assessed for eligibility. The study included 75 adults diagnosed with systolic dysfunction, ADHF, and a thirty-six hour inpatient length of stay or less. The control group (n=37) was prescribed the standard hospital diet which included a liberal sodium and fluid intake diet while the intervention group (n=38) followed a maximum fluid intake of 800 mL per day and maximum sodium restriction of 800 mg per day. The primary measured outcomes included weight loss and clinical stability at the three day assessment.

Weight loss was similar in both groups as well as clinical congestion score at day three. The intervention group reported increased levels of thirst and readmission rate at thirty days showed no difference between groups. Patients in the intervention group had more congestion than their constituents in the control group at the thirty day follow-up. Average BNP levels were elevated and similar in both groups. At the end of the study, both groups had a similar reduction in mean BNP levels.

In conclusion, aggressive sodium restriction coupled with fluid restriction in patients with ADHF did not show improved outcomes in weight loss or clinical stability at day three because no effect had been proven. The study suggests that it may be safe to recommend liberalizing fluid and sodium restrictions in patients with ADHF. This poses new implications for clinical dietitian application. Due to the relatively small differences in interventions, doubts still remain as to the potential harm or benefit of fluid and sodium restrictions.

Aliti GB, Rabelo ER, Clausell N, Rohde LE, Biolo A, Beck-da-Silva L. Aggressive fluid and sodium restriction in acute decompensated heart failure: a randomized clinical trial. JAMA Intern Med. 2013;173(12):1058-1064. doi:10.1001/jamainternmed.2013.552.

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