Effect of fluid and sodium restrictions on weight loss among patients with heart failure

A clinical trial of 75 patients hospitalized with acute decompensated heart failure (ADHF) suggests that aggressive fluid and sodium restriction has no effect on weight loss or clinical stability at three days but was associated with an increase in perceived thirst, according to a study published Online First by JAMA Internal Medicine.

Sodium and fluid restrictions are nonpharmacologic measures widely used to treat ADHF despite a lack of clear evidence of their therapeutic effect, the authors write in the study background.

"We conclude that sodium and water restriction in patients admitted for ADHF are unnecessary," Graziella Badin Aliti, R.N., Sc.D., of the Hospital de Clìnicas de Porto Alegre, Brazil, and colleagues comment in the study.

The clinical trial compared the effects of a fluid-restricted (maximum fluid intake, 800 mL/d) and sodium-restricted (maximum dietary intake, 800 mg/d) diet in an intervention group (IG) versus a diet with no such restrictions in a control group (CG). The main outcomes the authors measured were weight loss and clinical stability at the three-day assessment, as well as daily perception of thirst and readmissions within 30 days.

According to the results, weight loss was similar in both groups (between-group difference in variation of 0.25kg) as well as the change in clinical congestion score (between-group difference in variation of 0.59 points) at three days. Thirst was increased in the IG, but there were no significant between-group differences in the readmission rate at 30 days, the results indicate.

"In summary, this RCT contributes to the field of HF [heart failure] research by showing that, in patients with ADHF, aggressive fluid and sodium restriction had no effect on weight loss or clinical stability compared with a diet with liberal fluid and sodium intakes. Furthermore, this aggressive intervention was associated with significantly higher rates of perceived thirst," the study concludes.