Thirst in stable heart failure patients; time to reconsider fluid restriction and prescribed diuretics

Abstract

Aims One of the bothersome symptoms that heart failure (HF) patients can experience is thirst. There are limited data on the association between thirst and fluid intake and clinical variables. Therefore, the aim of this study was to describe severe thirst in stable HF patients and assess factors related to severe thirst, including actual fluid intake and sodium intake. Methods and resultsThe study had a cross-sectional design. Stable HF patients from two HF clinics in the Netherlands were included and assessed thirst by a visual analogue scale ranging from 0 to 100. They also completed questionnaires on thirst distress, self-care behaviour, and HF symptoms. A 3 day food diary was completed to assess actual fluid intake and sodium intake. Finally, patients collected urine for 24 h. Patients were divided into severe and low thirst based on thirst score and thirst distress. T-tests, Mann-Whitney tests, and χ 2 tests were conducted to assess differences between both groups. Multivariable logistic regression analysis was performed to assess factors associated with severe thirst. A total of 100 patients were included (40% female, mean age 72 ± 12) of which 68 completed the food diary. The mean thirst score was 28 ± 25, and 25% experienced severe thirst. The majority of patients (94%) were prescribed a fluid restriction, 37% had a restriction between 1500 and 2000 mL, and 32% a restriction of 1500 mL. Severe thirst in the total group with 100 patients was associated with a higher dose of loop diuretics [odds ratio (OR) 3.25; 95% confidence interval (CI) 1.01-10.45; P = 0.048] and a higher urine output over 24 h (OR 1.002; 95% CI 1.00-1.003; P = 0.010). In the group of patients who completed the food diary (N = 68), severe thirst was associated with a higher sodium intake (OR 1.002; 95% CI 1.001-1.003; P = 0.003), a higher dose of loop diuretics (OR 22.69;; P = 0.004), and more fatigue (OR 11.2; 95% CI 1.54-82.12; P = 0.017). Conclusions A quarter of all stable HF patients experienced severe thirst. A higher dose of loop diuretics was associated with more thirst; therefore, it might be important to review the dose of loop diuretics critically and try to decrease it in order to relieve severe thirst. Because all patients were prescribed a fluid restriction, a reconsideration of this restriction is also suggested.

Loop diuretics in heart failure: The objective markers to guide the therapy are needed

“…Furthermore, the excessive (diuretic mediated) sodium and water loss is counterbalanced with excessive thirst, and therefore, another vicious circle may be created. 5 Some premises exist that the diuretic effect of most drugs (especially diuretics and SGLT-2) gets blunted with time once some adaptive mechanisms come into play. 6,7 This is probably why the more advanced HF patients (patients who take diuretics for longer periods of time) need higher doses of the drugs.…”

“…In addition, diuretics were shown to directly excite the RAA system by blocking the macula densa and thus promoting renin release. Furthermore, the excessive (diuretic mediated) sodium and water loss is counterbalanced with excessive thirst, and therefore, another vicious circle may be created 5 …”

“…Furthermore, the excessive (diuretic mediated) sodium and water loss is counterbalanced with excessive thirst, and therefore, another vicious circle may be created. 5 …”