Salt and Water Restriction in Decompensated HF
Salt and Water Restriction in Decompensated HF
The study by Aliti et al. was a single center, randomized, blinded, parallel group clinical trial that included adult patients admitted to the hospital with the diagnosis of ADHF, excluding those with advanced renal failure, cardiogenic shock and severe comorbidities that could compromise survival. The study screened a total of 813 patients for eligibility, out of which 783 patients were excluded for various reasons and only 75 patients entered the study. Patients were randomized within 36 h of admission into two groups in terms of the amount of fluid and salt intake permitted during the subsequent 3 days after randomization. A total of 38 patients were randomized to the Intervention Group (IG) and allowed maximum sodium and fluid intake of 800 mg/day and 800 ml/day, respectively, and 37 patients were assigned to the Control Group (CG) and allowed 3–5 g of sodium intake with a minimum of 2.5 l fluid intake a day. Final analysis was done on 75 patients in the IG and 71 patients in the CG. Patients underwent daily assessments including congestion score, perceived thirst, body weight and use of vasoactive drugs. Baseline characteristics including age, gender, etiology of heart failure (HF), LV function, functional class and treatment with diuretics and neurohormonal antagonists were well matched between the two groups.
Primary end points included weight loss and clinical stability at day 3 post-randomization. Parameters of clinical stability were defined as improvement in congestion score and cessation of all use of intravenous diuretics and vasoactive drugs. Secondary end points included patients' perceived thirst using a visual analog scale from 0 to 10 and the rate of readmission due to HF at 30 days post-discharge.
At day 3 of the assessment, there was no difference between the IG and CG groups in change of body weight (-4.42 kg vs -4.67; p = 0.82), respectively. Both groups achieved the same level of clinical stability compared with baseline. In regard to perceived thirst, both groups were matched at baseline for the mean thirst score; however, more thirst was detected in the IG at the end of study period (p = 0.01). There was no difference between the two groups in the mean dose of intravenous loop diuretics, percentage of patients receiving vasoactive therapies and the median time required to transition intravenous diuretics to oral forms. Similarly, there were no differences in balance of serum electrolytes and renal function during the study duration. At 30 days follow-up, patients in the IG were more congested with a 2.4 point higher congestion score than their CG counterparts (95% CI: 0.94–3.99; p = 0.02). The 30-day readmission rate for HF was 29% in the IG and 19% in the CG (p = 0.41).
Method and Result
The study by Aliti et al. was a single center, randomized, blinded, parallel group clinical trial that included adult patients admitted to the hospital with the diagnosis of ADHF, excluding those with advanced renal failure, cardiogenic shock and severe comorbidities that could compromise survival. The study screened a total of 813 patients for eligibility, out of which 783 patients were excluded for various reasons and only 75 patients entered the study. Patients were randomized within 36 h of admission into two groups in terms of the amount of fluid and salt intake permitted during the subsequent 3 days after randomization. A total of 38 patients were randomized to the Intervention Group (IG) and allowed maximum sodium and fluid intake of 800 mg/day and 800 ml/day, respectively, and 37 patients were assigned to the Control Group (CG) and allowed 3–5 g of sodium intake with a minimum of 2.5 l fluid intake a day. Final analysis was done on 75 patients in the IG and 71 patients in the CG. Patients underwent daily assessments including congestion score, perceived thirst, body weight and use of vasoactive drugs. Baseline characteristics including age, gender, etiology of heart failure (HF), LV function, functional class and treatment with diuretics and neurohormonal antagonists were well matched between the two groups.
Primary end points included weight loss and clinical stability at day 3 post-randomization. Parameters of clinical stability were defined as improvement in congestion score and cessation of all use of intravenous diuretics and vasoactive drugs. Secondary end points included patients' perceived thirst using a visual analog scale from 0 to 10 and the rate of readmission due to HF at 30 days post-discharge.
At day 3 of the assessment, there was no difference between the IG and CG groups in change of body weight (-4.42 kg vs -4.67; p = 0.82), respectively. Both groups achieved the same level of clinical stability compared with baseline. In regard to perceived thirst, both groups were matched at baseline for the mean thirst score; however, more thirst was detected in the IG at the end of study period (p = 0.01). There was no difference between the two groups in the mean dose of intravenous loop diuretics, percentage of patients receiving vasoactive therapies and the median time required to transition intravenous diuretics to oral forms. Similarly, there were no differences in balance of serum electrolytes and renal function during the study duration. At 30 days follow-up, patients in the IG were more congested with a 2.4 point higher congestion score than their CG counterparts (95% CI: 0.94–3.99; p = 0.02). The 30-day readmission rate for HF was 29% in the IG and 19% in the CG (p = 0.41).
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