Skip to main content
Log in

Effects of limiting fluid intake on clinical and laboratory outcomes in patients with heart failure

Results of a meta-analysis of randomized controlled trials

Auswirkungen einer begrenzten Flüssigkeitsaufnahme auf die klinischen und Laborwertergebnisse bei Patienten mit Herzversagen

Ergebnisse einer Metaanalyse von randomisierten kontrollierten Studien

  • Original article
  • Published:
Herz Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11

Similar content being viewed by others

References

  1. Dickstein K, Cohen-Solal A, Filippatos G et al (2008) ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur Heart J 29:2388–2442

    Article  CAS  PubMed  Google Scholar 

  2. Hunt SA, Abraham WT, Chin MH et al (2009) Focused update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the International Society for Heart and Lung Transplantation. J Am Coll Cardiol 53:e1–e90

    Article  Google Scholar 

  3. McMurray JJ, Adamopoulos S, Anker SD et al (2012) ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 14:803–869

    Article  CAS  PubMed  Google Scholar 

  4. Travers B, O’Loughlin C, Murphy NF, Ryder M, Conlon C, Ledwidge M, McDonald K (2007) Fluid restriction in the management of decompensated heart failure: no impact on time to clinical stability. J Card Fail 13(2):128–132

    Article  PubMed  Google Scholar 

  5. Holst M, Strömberg A, Lindholm M, Willenheimer R (2008) Liberal versus restricted fluid prescription in stabilised patients with chronic heart failure: result of a randomised cross-over study of the effects on health-related quality of life, physical capacity, thirst and morbidity. Scand Cardiovasc J 42(5):316–322

    Article  PubMed  Google Scholar 

  6. Philipson H, Ekman I, Forslund HB, Swedberg K, Schaufelberger M (2013) Salt and fluid restriction is effective in patients with chronic heart failure. Eur J Heart Fail 15(11):1304–1310

    Article  CAS  PubMed  Google Scholar 

  7. Paterna S, Parrinello G, Cannizzaro S, Fasullo S, Torres D, Sarullo FM, Di Pasquale P (2009) Medium term effects of different dosage of diuretic, sodium, and fluid administration on neurohormonal and clinical outcome in patients with recently compensated heart failure. Am J Cardiol 103(1):93–102

    Article  CAS  PubMed  Google Scholar 

  8. Albert NM, Nutter B, Forney J, Slifcak E, Tang WH (2013) A randomized controlled pilot study of outcomes of strict allowance of fluid therapy in hyponatremic heart failure (SALT-HF). J Card Fail 19(1):1–9

    Article  PubMed  Google Scholar 

  9. Aliti GB, Rabelo ER, Clausell N, Rohde LE, Biolo A, Beck-da-Silva L (2013) Aggressive fluid and sodium restriction in acute decompensated heart failure: a randomized clinical trial. JAMA Intern Med 173(12):1058–1064

    Article  CAS  PubMed  Google Scholar 

  10. Holst M, Strömberg A, Lindholm M, Willenheimer R (2008) Description of self-reported fluid intake and its effects on body weight, symptoms, quality of life and physical capacity in patients with stable chronic heart failure. J ClinNurs 17:2318–2326

    Google Scholar 

  11. De Vecchis R, Ciccarelli A, Pucciarelli A (2010) Unloading therapy by intravenous diuretic in chronic heart failure: a double-edged weapon? J Cardiovasc Med (Hagerstown) 11(8):571–574

    Google Scholar 

  12. Li Y, Fu B, Qian X (2015) Liberal versus restricted fluid administration in heart failure patients. Int Heart J 56(2):192–195

    Article  PubMed  Google Scholar 

  13. Brännström M, Ekman I, Norberg A, Boman K, Strandberg G (2006) Living with severe chronic heart failure in palliative advanced home care. Eur J Cardiovasc Nurs 5:295–302

    Article  PubMed  Google Scholar 

  14. Falk S, Wahn A-K, Lidell E (2007) Keeping the maintenance of daily life in spite of chronic heart failure. A qualitative study. Eur J Cardiovasc Nurs 6:192–199

    Article  PubMed  Google Scholar 

  15. van derWal MHL, Jaarsma T, Moser DK, van Gilst WH, van Veldhuisen DJ. Qualitative examination of compliance in heart failure patients in the Netherlands. Heart Lung 39:121–130

  16. Feigenbaum MS, Welsch MA, Mitchell M, Vincent K, Braith RW, Pepine CJ (2000) Contracted plasma and blood volume in chronic heart failure. J Am Coll Cardiol 39:51–55

    Article  Google Scholar 

  17. Schrier RW (2007) Decreased effective blood volume in edematous disorders: what does this mean? J Am Soc Nephrol 18:2028–2031

    Article  PubMed  Google Scholar 

  18. Valania G, Singh M, Slawsky MT (2011) Targeting hyponatremia and hemodynamics in acute decompensated heart failure: is there a role for vasopressin antagonists? Curr Heart Fail Rep 8:198–205

    Article  CAS  PubMed  Google Scholar 

  19. De Vecchis R, Ariano C, Esposito C, Giasi A, Cioppa C, Cantatrione S (2012) In right or biventricular chronic heart failure addition of thiazides to loop diuretics to achieve a sequential blockade of the nephron is associated with increased risk of dilutional hyponatremia: results of a case-control study. Minerva Cardioangiol 60(5):517–529

    PubMed  Google Scholar 

  20. Waldréus N, Hahn RG, Jaarsma T (2013) Thirst in heart failure: a systematic literature review. Eur J Heart Fail 15(2):141–149

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to R. De Vecchis.

Ethics declarations

Conflict of interest

R. Vecchis, C. Baldi, C. Cioppa, A. Giasi, and A. Fusco state that there are no conflicts of interest.

The accompanying manuscript does not include studies on humans or animals.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00059-015-4345-9

Keywords

Schlüsselwörter

Navigation