The Importance of Optimal Hydration in Patients with Heart Failure—Not Always Too Much Fluid

Abstract

Heart failure (HF) is a leading cause of morbidity and mortality and a major public health problem. Both overhydration and dehydration are non-physiological states of the body that can adversely affect human health. Congestion and residual congestion are common in patients hospitalized for HF and are associated with poor prognosis and high rates of rehospitalization. However, the clinical problem of dehydration is also prevalent in healthcare and community settings and is associated with increased morbidity and mortality. This article provides a comprehensive review of the issue of congestion and dehydration in HF, including HF guidelines, possible causes of dehydration in HF, confirmed and potential new diagnostic methods. In particular, a full database search on the relationship between dehydration and HF was performed and all available evidence in the literature was reviewed. The novel hypothesis of chronic subclinical hypohydration as a modifiable risk factor for HF is also discussed. It is concluded that maintaining euvolemia is the cornerstone of HF management. Physicians have to find a balance between decongestion therapy and the risk of dehydration.

Impact of homeostatic body hydration status, evaluated by hemodynamic measures, on different pain sensitization paths to a chronic pain syndrome

“…Common measures for assessing body hydration levels, such as total body water content and plasma/urine osmolality, are not ideal for indicating homeostatic hyper-, normo-, or hypo-hydration status in an individual. This is because they rely on population-derived ranges that cannot determine whether specific values of body hydration in individuals are within or outside their individual homeostatic ranges, as they do not assess compensating or regulating physiological responses to those hydration states 37 . In patients, medical histories, clinical features, and physical examinations, often with referral to specialists, along with the empiric ('trial and error') treatment method suggested by contemporary hypertension treatment guidelines, remain the standard for stratifying patients into these two different types of hypertension and determining their distinct care 38 .…”

“…However, these methods are less suitable for individuals sampled from a general population 39 . Thus, the insufficiencies in traditional metabolic and clinical indicators of individually optimal body hydration states have been recognized as a problem in cardiovascular medicine 37 , 40 .…”