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Role of Sodium and Sodium Restriction in Heart Failure

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Abstract

Purpose of Review

Sodium plays an essential role in the regulation of extracellular volume. The current review discusses the physiologic handling of sodium in the body, underscores pathophysiologic alterations in sodium handling in heart failure and assesses the evidence and rational for sodium restriction in heart failure.

Recent Findings

Recent trials such as the SODIUM-HF trial have failed to demonstrate a benefit of sodium restriction in heart failure. The current review re-evaluates physiologic elements in sodium handling and discusses how the intrinsic renal sodium avidity, which drives the renal propensity towards retaining sodium, differs amongst patients.

Summary

The sodium intake in heart failure patients is often above the threshold set by guidelines. This review gives an overview of the pathophysiology of sodium retention in heart failure and the rational for sodium restriction and potential of individualizing sodium restriction recommendations based on renal sodium avidity profiles.

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Data Availability

This manuscript is the result of a literature review and no original data that can be potentially shared is linked to this manuscript.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Acknowledgements

The editors would like to thank Drs. Christiane Angermann and Pierpaolo Pellicori for taking to the time to handle the review of this manuscript.

Funding

Dr. Martens is supported by a grant from the Belgian American Educational Foundation (BAEF) and the Frans Van de Werf Fund. Dr. Tang is supported by grants from the National Institutes of Health (R01HL146754).

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Authors and Affiliations

  1. Kaufman Center for Heart Failure Treatment and Recovery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J3-4, Cleveland, OH, 44195, USA

    Pieter Martens & W. H. Wilson Tang

Authors
  1. Pieter Martens
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  2. W. H. Wilson Tang
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Corresponding author

Correspondence to Pieter Martens.

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Conflict of Interest

Dr. Martens has received consultancy fees from AstraZeneca, Abbott, Bayer, Boehringer-Ingelheim, Daiichi Sankyo, Novartis, Novo Nordisk and Vifor pharma. Dr. Tang is a consultant for Sequana Medical, Cardiol Therapeutics, Genomics plc, Zehna Therapeutics, Renovacor, WhiteSwell, Boston Scientific, Kiniksa, and has received honorarium from Springer Nature and American Board of Internal Medicine.

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Martens, P., Tang, W.H.W. Role of Sodium and Sodium Restriction in Heart Failure. Curr Heart Fail Rep 20, 230–236 (2023). https://doi.org/10.1007/s11897-023-00607-z

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  • DOI: https://doi.org/10.1007/s11897-023-00607-z

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