Sodium Restriction in Heart Failure: Benefit or Harm?

Abstract

Opinion Statement Current guidelines vary in the recommended amount of dietary sodium intake for heart failure (HF) patients. Observational studies and the hypertension literature support the concept that sodium restriction improves HF outcomes. In contrast, several randomized controlled trials imply that dietary sodium restriction can cause harm through hypovolemia and increased neurohormonal activation. Data from hypertensive animal models and humans suggest that dietary sodium intake may need to be individually tailored based on HF severity and the physiologic response to sodium loading. Future studies must assess interactions between sodium intake, fluid intake, and diuretics to match clinical practice and improve safety. More information is needed in multiple areas, including accurate measurement of sodium intake, implementation of dietary changes in HF patients, and establishment of biomarkers that predict response to changes in sodium intake. Additional research is urgently needed to determine the true impact of the most commonly recommended self-care strategy in HF.

Focus on renal congestion in heart failure

“…Salt and water restriction for routine management of HF is usually based on expert opinion rather than evidence-based proof [ 57 ]. Fluid restriction (1000 mL/day) in hyponatremic (serum sodium <137 mmol/dL) patients with HF improved the quality of life at 60 days after discharge [ 58 ].…”

“…In elderly people, dietary sodium restriction might even cause harm through hypovolemia and increased neurohormonal activation, causing falls and their associated morbidity. Dietary sodium intake should be individually tailored based on HF severity and the physiologic response to sodium loading [ 57 ]. Thus, future clinical studies are needed to assess the effectiveness of sodium and fluid restriction in different stages and clinically divergent HF patients.…”

Does Limiting Salt Intake Prevent Heart Failure? A Critical Appraisal

“…Increased neurohormonal activation very well may account for the relatively modest reduction in blood pressure with sodium restriction in this meta-analysis (BP decrease of 1 % in normotensives and 3.5 % in hypertensive patients) [48]. It is worth noting that a similar neurohormonal response to sodium restriction has been observed in HF patients and has led to debate regarding whether sodium should be restricted even in prevalent HF [49,50].…”

Health Promotion and Self-Management Among Patients with Chronic Heart Failure

“…Similarly, the 2016 European Society of Cardiology (ESC) guideline for diagnosis and treatment of HF does not provide any explicit recommendation on sodium restriction but suggesting avoiding excessive salt intake (>6 g/day) [51]. Most of these recommendations are based on expert opinions given the conflicting evidences in the literature, which make it difficult to compare or draw definite conclusions [50,[52][53][54].…”