title: Aggressive fluid and sodium restriction in acute decompensated heart failure: a randomized clinical trial.
abstract: OBJECTIVE
  The benefits of fluid and sodium restriction in patients hospitalized with acute decompensated heart failure (ADHF) are unclear.
  
  
  OBJECTIVE
  To compare the effects of a fluid-restricted (maximum fluid intake, 800 mL/d) and sodium-restricted (maximum dietary intake, 800 mg/d) diet (intervention group [IG]) vs a diet with no such restrictions (control group [CG]) on weight loss and clinical stability during a 3-day period in patients hospitalized with ADHF.
  
  
  METHODS
  Randomized, parallel-group clinical trial with blinded outcome assessments.
  
  
  METHODS
  Emergency room, wards, and intensive care unit.
  
  
  METHODS
  Adult inpatients with ADHF, systolic dysfunction, and a length of stay of 36 hours or less.
  
  
  METHODS
  Fluid restriction (maximum fluid intake, 800 mL/d) and additional sodium restriction (maximum dietary intake, 800 mg/d) were carried out until the seventh hospital day or, in patients whose length of stay was less than 7 days, until discharge. The CG received a standard hospital diet, with liberal fluid and sodium intake.
  
  
  METHODS
  Weight loss and clinical stability at 3-day assessment, daily perception of thirst, and readmissions within 30 days.
  
  
  RESULTS
  Seventy-five patients were enrolled (IG, 38; CG, 37). Most were male; ischemic heart disease was the predominant cause of heart failure (17 patients [23%]), and the mean (SD) left ventricular ejection fraction was 26% (8.7%). The groups were homogeneous in terms of baseline characteristics. Weight loss was similar in both groups (between-group difference in variation of 0.25 kg [95% CI, -1.95 to 2.45]; P = .82) as well as change in clinical congestion score (between-group difference in variation of 0.59 points [95% CI, -2.21 to 1.03]; P = .47) at 3 days. Thirst was significantly worse in the IG (5.1 [2.9]) than the CG (3.44 [2.0]) at the end of the study period (between-group difference, 1.66 points; time × group interaction; P = .01). There were no significant between-group differences in the readmission rate at 30 days (IG, 11 patients [29%]; CG, 7 patients [19%]; P = .41).
  
  
  CONCLUSIONS
  Aggressive fluid and sodium restriction has no effect on weight loss or clinical stability at 3 days and is associated with a significant increase in perceived thirst. We conclude that sodium and water restriction in patients admitted for ADHF are unnecessary.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT01133236.
authors.affiliation: Postgraduate Program in Cardiovascular Sciences, Cardiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Graziella Badin
authors.initials: GB
authors.lastname: Aliti
authors.forename: Eneida R
authors.initials: ER
authors.lastname: Rabelo
authors.forename: Nadine
authors.initials: N
authors.lastname: Clausell
authors.forename: Luís E
authors.initials: LE
authors.lastname: Rohde
authors.forename: Andreia
authors.initials: A
authors.lastname: Biolo
authors.forename: Luis
authors.initials: L
authors.lastname: Beck-da-Silva
mesh_terms: D000208:Acute Disease; D000368:Aged; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D004039:Diet, Sodium-Restricted / Q000379:methods; D004311:Double-Blind Method; D060766:Drinking Water / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood / Q000178:diet therapy* / Q000503:physiopathology; D006801:Humans; D007297:Inpatients; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D018570:Risk Assessment; D012307:Risk Factors; D013894:Thirst; D016896:Treatment Outcome; D015431:Weight Loss
chemical_list: D015415:Biomarkers; D060766:Drinking Water; D020097:Natriuretic Peptide, Brain