title: Fluid restriction in patients with heart failure: how should we think?
abstract: Fluid restriction has long been considered one of the cornerstones in self-care management of patients with heart failure. The aim of this discussion paper is to discuss fluid restriction in heart failure and propose advice about fluid intake in heart failure patients.
  
  
  
  Although there have been seven randomised studies on fluid restriction in heart failure patients, the effect of fluid restriction on its own were only evaluated in two studies. In both studies, a stringent fluid restriction compared to a liberal fluid intake was not more beneficial with regard to clinical stability or body weight. In the other studies fluid restriction was part of a larger study intervention including, for example, individualised dietary recommendations and follow-up by telephone. Thus, the effect of fluid restriction on its own has been poorly evaluated.
  
  
  
  Fluid restriction should not be recommended to all heart failure patients. However, temporary fluid restriction can be considered in decompensated heart failure and/or patients with hyponatremia. Tailored fluid restriction based on body weight (30 ml/kg per day) seems to be most reasonable. To increase adherence to temporary fluid restriction, education, support and planned evaluations can be recommended.
authors.affiliation: Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden peter.johansson@kindamail.se.
authors.forename: Peter
authors.initials: P
authors.lastname: Johansson
authors.affiliation: Department of Cardiology, University of Groningen, the Netherlands Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden.
authors.forename: Martje Hl
authors.initials: MH
authors.lastname: van der Wal
authors.affiliation: Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Strömberg
authors.affiliation: Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden Department of Research, Södertälje Sjukhus, Sweden.
authors.forename: Nana
authors.initials: N
authors.lastname: Waldréus
authors.affiliation: Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden.
authors.forename: Tiny
authors.initials: T
authors.lastname: Jaarsma
mesh_terms: D005440:Fluid Therapy; D006333:Heart Failure / Q000451:nursing*; D006801:Humans; D011788:Quality of Life; D012648:Self Care
keywords: Heart failure; fluid restriction; management