Abstract
Background
The guidelines of the Scientific Societies of Cardiology recommend limiting fluid intake as a nonpharmacological measure for the management of chronic heart failure (HF). However, many patients with HF may suffer from severe thirst. A meta-analysis was performed to evaluate the effect of limiting fluid consumption based on various clinical and laboratory outcomes in patients with chronic HF.
Methods
Only randomized controlled trials comparing liberal and restricted fluid oral intake in patients with HF were included. Primary outcomes were HF hospitalizations and all-cause mortality. Secondary outcomes were the sensation of thirst, the duration of therapy with intravenous diuretics, and the serum levels of creatinine, sodium, and B-type natriuretic peptide (BNP).
Results
Six studies met the inclusion criteria. Significant heterogeneity was detected for the majority of outcomes. In 5 studies, patients with restricted fluid intake compared to patients with free consumption of beverages had similar rehospitalization and mortality rates. There were no differences regarding patients’ sense of thirst (4 studies), duration of intravenous diuretic treatment (2 studies), serum creatinine levels (5 studies), and serum sodium levels (5 studies). Serum BNP levels were significantly higher in the group with free fluid intake (4 studies).
Conclusion
In patients with HF, liberal fluid consumption does not seem to exert an unfavorable impact on HF rehospitalizations or all-cause mortality. Further randomized controlled trials are warranted to definitively confirm the present findings.
Zusammenfassung
Hintergrund
Die Leitlinien der Fachgesellschaften für Kardiologie haben eine begrenzte Flüssigkeitsaufnahme als eine nichtpharmakologische Maßnahme zum Management von chronischem Herzversagen (HV) empfohlen. Jedoch leiden viele Patienten mit HV an starkem Durst. Eine Metaanalyse wurde durchgeführt, um die Auswirkung einer Begrenzung der Flüssigkeitsaufnahme auf verschiedene klinische und Laborwertergebnisse bei Patienten mit chronischem HV zu evaluieren.
Methoden
Es wurden ausschließlich randomisierte kontrollierte Studien eingeschlossen, welche die uneingeschränkte und die eingeschränkte orale Flüssigkeitsaufnahme bei Patienten mit HV vergleichen. Die primären Outcomes waren Hospitalisationen wegen HV sowie die Gesamtmortalität. Die sekundären Outcomes waren Durstgefühl, Dauer der Therapie mit intravenösen Diuretika sowie Serumwerte von Kreatinin, Natrium und natriuretischem Peptid Typ B (BNP).
Ergebnisse
Sechs Studien erfüllten die Einschlusskriterien. Bei der Mehrzahl der Ergebnisse wurde eine signifikante Heterogenität beobachtet. In 5 Studien zeigten Patienten mit begrenzter Flüssigkeitsaufnahme im Vergleich zu Patienten mit uneingeschränktem Getränkekonsum ähnliche Rehospitalisations- und Mortalitätsraten. Es gab bei den Patienten keinen Unterschied hinsichtlich Durstgefühls (4 Studien), Dauer der intravenösen Therapie mit Diuretika (2 Studien), Serum-Kreatininwerten (5 Studien) und Serum-Natriumwerten (5 Studien). Die Serum-BNP-Werte waren signifikant höher in der Gruppe mit uneingeschränkter Flüssigkeitsaufnahme (4 Studien).
Schlussfolgerung
Bei Patienten mit HV scheint eine uneingeschränkte Flüssigkeitsaufnahme keinen nachteiligen Effekt auf die Rehospitalisationen wegen HV oder die Gesamtmortalität zu haben. Weitere randomisierte kontrollierte Studien werden die aktuellen Ergebnisse mit großer Sicherheit abschließend bestätigen.
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R. Vecchis, C. Baldi, C. Cioppa, A. Giasi, and A. Fusco state that there are no conflicts of interest.
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De Vecchis, R., Baldi, C., Cioppa, C. et al. Effects of limiting fluid intake on clinical and laboratory outcomes in patients with heart failure. Herz 41, 63–75 (2016). https://doi.org/10.1007/s00059-015-4345-9
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DOI: https://doi.org/10.1007/s00059-015-4345-9