Liberal fluid intake versus fluid restriction in chronic heart failure: a randomized clinical trial
In stable chronic heart failure patients, advising liberal fluid intake instead of the usual restriction did not worsen health status or safety and caused less thirst, questioning the routine practice of fluid restriction.
Background
Fluid restriction is frequently recommended to patients with chronic heart failure, yet randomized trials assessing its effects are scarce, leaving the practice largely unsupported by high-quality evidence.
Study design
This multicenter, open-label trial randomized 504 chronic heart failure outpatients to advice for liberal fluid intake versus fluid restriction up to 1,500 mL/day. The primary outcome was health status at 3 months measured by the Kansas City Cardiomyopathy Questionnaire Overall Summary Score (KCCQ-OSS).
Key findings
At 3 months the KCCQ-OSS was 74.0 in the liberal group versus 72.2 in the restriction group (adjusted mean difference 2.17; 95% CI -0.06 to 4.39; P=0.06), so the primary outcome was not met. Thirst distress was higher in the restriction group.
Clinical implications
These findings question the benefit of routine fluid restriction in chronic heart failure and support a more individualized approach, relevant when comanaging cardiorenal patients.
Safety
No differences in safety events were observed between the two groups.
Category
Research
Source
Nature Medicine
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