Aggressive fluid and sodium restriction in decompensated heart failure with preserved ejection fraction: Results from a randomized clinical trial.

Karina Sanches Machado d'Almeida, Eneida Rejane Rabelo-Silva, Gabriela Corrêa Souza, Melina Maria Trojahn, Sofia Louise Santin Barilli, Graziella Aliti, Luís Eduardo Rohde, Andreia Biolo, Luís Beck-da-Silva

Journal: Nutrition (Burbank, Los Angeles County, Calif.) 2019;54():111-117

PMID: 29793053

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Abstract

OBJECTIVES

Sodium and fluid restriction is commonly prescribed for heart failure patients. However, its role in the treatment of heart failure with preserved ejection fraction (HFpEF) remains unclear. The aim of this study was to compare the effect of a diet with sodium and fluid restriction with an unrestricted diet in patients admitted for decompensated HFpEF.

METHODS

Patients were randomized to a diet with sodium (0.8 g/d) and fluid (800 mL/d) restriction (intervention group [IG]) or an unrestricted diet (control group [CG]) and followed for 7 d or hospital discharge. The primary outcome was weight loss. Secondary outcomes included clinical stability, perception of thirst, neurohormonal activation, nutrient intake, readmission, and mortality rate after 30 d.

RESULTS

Fifty-three patients were included (30, IG; 23, CG). The mean ejection fraction was 62% ± 8% for IG and 60% ± 7% for CG (P = 0.44). Weight loss was similar in both groups, being 1.6 ± 2.2 kg in the IG and 1.8 ± 2.1 kg in CG (P = 0.49) as well as the reduction in the congestion score (IG = 3.4 ± 3.5; CG = 3.8 ± 3.4; P = 0.70). The daily perception of thirst was higher in the IG (P = 0.03). Lower energy consumption was seen in the IG (P <0.001). No significant between-group differences at 30 d were found.

CONCLUSIONS

Aggressive sodium and fluid restriction does not provide symptomatic or prognosis benefits, but does produce greater perception of thirst, may impair the patient's food intake, and does not seem to have an important neurohormonal effect in patients admitted for decompensated HFpEF.

Address: Post Graduate Program in Health Sciences, Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Nutrition Program, Universidade Federal do Pampa, UNIPAMPA, Itaqui, RS, Brazil; Heart Failure and Transplant Group, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.; Post Graduate Program in Health Sciences, Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Heart Failure and Transplant Group, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; School of Nursing, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.; Heart Failure and Transplant Group, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Department of Internal Medicine, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.; Heart Failure and Transplant Group, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.; Heart Failure and Transplant Group, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; School of Nursing, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.; Post Graduate Program in Health Sciences, Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Heart Failure and Transplant Group, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Department of Internal Medicine, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.; Post Graduate Program in Health Sciences, Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Heart Failure and Transplant Group, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil. Electronic address: [email protected].

DOI: 10.1016/j.nut.2018.02.007

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MeSH Terms: Aged, Aged, 80 and over, Diet, Sodium-Restricted, Energy Intake, Female, Heart Failure, Humans, Male, Middle Aged, Prognosis, Stroke Volume, Thirst, Treatment Outcome, Water Deprivation, Weight Loss