Fluid restriction in patients with heart failure: how should we think?

Abstract

Fluid restriction should not be recommended to all heart failure patients. However, temporary fluid restriction can be considered in decompensated heart failure and/or patients with hyponatremia. Tailored fluid restriction based on body weight (30 ml/kg per day) seems to be most reasonable. To increase adherence to temporary fluid restriction, education, support and planned evaluations can be recommended.

Trajectory of thirst intensity and distress from admission to 4-weeks follow up at home in patients with heart failure

“… 24 , 25 However, no convincing evidence is found for the standard prescription of fluid restriction for all patients with HF. 26 The negative effect of fluid restriction on thirst distress is supported in a study in which patients with HF had increased thirst distress over time while having prescribed a fluid restriction, even though the patients received education and behavioral strategies to manage the restriction. 13 Suffering from thirst caused by fluid restriction should be seriously considered, and such a restriction should only be prescribed in patients who can truly benefit from it.…”

“… 13 Suffering from thirst caused by fluid restriction should be seriously considered, and such a restriction should only be prescribed in patients who can truly benefit from it. 26 According to guidelines, fluid restriction is not recommended for all patients with HF. 24 – 27 A temporary fluid restriction can be beneficial for patients with HF who have fluid overload, severe edema and/or ascites and/or with hyponatremia, in order to relieve congestion and symptoms.…”

Health education: the effectiveness of interventions in patients with heart failure

“…Fluid restriction has long been considered one of the cornerstones in the management of SC of patients with HF. Nonetheless, this recommendation lacks solid scientific evidence (22) . Given the evidence available by the 2018 Brazilian Guideline for Acute and Chronic Heart Failure (Diretriz Brasileira de Insuficiência Cardíaca Crônica e Aguda de 2018), it does not establish specific recommendations on FR in patients with HF (10) .…”

Problems Experienced in the Second and Third Months After Discharge From a Heart Failure-Related Hospitalization

“…Yet, data are unclear as to the safety and efficacy of restricting fluids, with some evidence indicating routine restriction may be unwarranted unless IHF have pulmonary congestion or decompensated HF. 13,14 Comorbidities emerged as a new problem in managing HF treatment and symptoms. For example, different glucose-lowering agents affect HF outcomes, 15,16 while pulmonary disease, diabetes mellitus, and obesity tend to increase morbidity and mortality risk in both IHF with a preserved or reduced ejection fraction.…”