A Randomized Controlled Pilot Study of Outcomes of Strict Allowance of Fluid Therapy in Hyponatremic Heart Failure (SALT-HF)

Albert, Nancy M.; Nutter, Benjamin; Forney, Jennifer; Slifcak, Ellen; Tang, W.H. Wilson

doi:10.1016/j.cardfail.2012.11.007

Cited by 58 publications

(71 citation statements)

References 17 publications

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“…8) Patients described difficulty adhering to their fluid restrictions in two studies. 6,8) Similar weight loss was reported in both groups in all studies reporting this outcome. 3,4,7,8) …”

Section: Subgroup Analysessupporting

confidence: 80%

“…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) 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%

“…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. Quality assessment of studies included: The Cochrane collaboration tool for assessing risk of bias showed some unclear risk in selection bias and high risk in attrition bias (16.7%) (Supplemental Figure 2).…”

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: 97%

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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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“…8) Patients described difficulty adhering to their fluid restrictions in two studies. 6,8) Similar weight loss was reported in both groups in all studies reporting this outcome. 3,4,7,8) …”

Section: Subgroup Analysessupporting

confidence: 80%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Subgroup Analysesmentioning

confidence: 97%

See 3 more Smart Citations

Liberal Versus Restricted Fluid Administration in Heart Failure Patients

Yang

Qian

2015

Int. Heart J.

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Interventions for chronic non-hypovolaemic hypotonic hyponatraemia

Nagler

Haller²,

Biesen

et al. 2018

Cochrane Database of Systematic Reviews

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In people with chronic hyponatraemia, vasopressin receptor antagonists modestly raise serum sodium concentration at the cost of a 3% increased risk of it being rapid. To date there is very low certainty evidence for patient-important outcomes; the effects on mortality and health-related quality of life are unclear and do not rule out appreciable benefit or harm; there does not appear to be an important effect on cognitive function, but hospital stay may be slightly shorter, although available data are limited. Treatment decisions must weigh the value of an increase in serum sodium concentration against its short-term risks and unknown effects on patient-important outcomes. Evidence for other treatments is largely absent.Further studies assessing standard treatments such as fluid restriction or urea against placebo and one-another would inform practice and are warranted. Given the limited available evidence for patient-important outcomes, any study should include these outcomes in a standardised manner.

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2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure

McDonagh¹,

Metra²,

Adamo³

et al. 2022

European J of Heart Fail

1,199

280

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Document Reviewers: Rudolf A. de Boer (CPG Review Coordinator) (Netherlands), P. Christian Schulze (CPG Review Coordinator) (Germany), Magdy Abdelhamid (Egypt), Victor Aboyans (France), Stamatis Adamopoulos (Greece), Stefan D. Anker (Germany), Elena Arbelo (Spain), Riccardo Asteggiano (Italy), Johann Bauersachs (Germany), Antoni Bayes‐Genis (Spain), Michael A. Borger (Germany), Werner Budts (Belgium), Maja Cikes (Croatia), Kevin Damman (Netherlands), Victoria Delgado (Netherlands), Paul Dendale (Belgium), Polychronis Dilaveris (Greece), Heinz Drexel (Austria), Justin Ezekowitz (Canada), Volkmar Falk (Germany), Laurent Fauchier (France), Gerasimos Filippatos (Greece), Alan Fraser (United Kingdom), Norbert Frey (Germany), Chris P. Gale (United Kingdom), Finn Gustafsson (Denmark), Julie Harris (United Kingdom), Bernard Iung (France), Stefan Janssens (Belgium), Mariell Jessup (United States of America), Aleksandra Konradi (Russia), Dipak Kotecha (United Kingdom), Ekaterini Lambrinou (Cyprus), Patrizio Lancellotti (Belgium), Ulf Landmesser (Germany), Christophe Leclercq (France), Basil S. Lewis (Israel), Francisco Leyva (United Kingdom), AleVs Linhart (Czech Republic), Maja‐Lisa Løchen (Norway), Lars H. Lund (Sweden), Donna Mancini (United States of America), Josep Masip (Spain), Davor Milicic (Croatia), Christian Mueller (Switzerland), Holger Nef (Germany), Jens‐Cosedis Nielsen (Denmark), Lis Neubeck (United Kingdom), Michel Noutsias (Germany), Steffen E. Petersen (United Kingdom), Anna Sonia Petronio (Italy), Piotr Ponikowski (Poland), Eva Prescott (Denmark), Amina Rakisheva (Kazakhstan), Dimitrios J. Richter (Greece), Evgeny Schlyakhto (Russia), Petar Seferovic (Serbia), Michele Senni (Italy), Marta Sitges (Spain), Miguel Sousa‐Uva (Portugal), Carlo G. Tocchetti (Italy), Rhian M. Touyz (United Kingdom), Carsten Tschoepe (Germany), Johannes Waltenberger (Germany/Switzerland) All experts involved in the development of these guidelines have submitted declarations of interest. These have been compiled in a report and published in a supplementary document simultaneously to the guidelines. The report is also available on the ESC website http://www.escardio.org/guidelines For the Supplementary Data which include background information and detailed discussion of the data that have provided the basis for the guidelines see European Heart Journal online

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A Randomized Controlled Pilot Study of Outcomes of Strict Allowance of Fluid Therapy in Hyponatremic Heart Failure (SALT-HF)

Cited by 58 publications

References 17 publications

Liberal Versus Restricted Fluid Administration in Heart Failure Patients

Liberal Versus Restricted Fluid Administration in Heart Failure Patients

Interventions for chronic non-hypovolaemic hypotonic hyponatraemia

2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure

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