Fluid intake impact on heart failure: Systematic review and meta-analysis with trial sequential analysis

Area of Science:

• Cardiology
• Nephrology
• Internal Medicine

Background:

• Heart failure (HF) management lacks clear guidelines on fluid balance.
• Some research suggests liberal fluid intake may benefit HF patients.
• This review evaluates unrestricted vs. restricted fluid intake, including sodium restriction, in adults with HF.

Purpose of the Study:

• To evaluate the clinical outcomes of liberal versus restricted fluid intake in adult heart failure patients.
• To assess the impact of sodium restriction within fluid intake strategies for HF management.

Main Methods:

• Systematic review and meta-analysis of studies on fluid intake in adult HF patients.
• Included nine studies with 961 participants, analyzing liberal vs. restricted fluid intake and sodium restriction.
• Calculated pooled odds ratios (OR) and weighted mean differences (WMD), using trial sequential analysis (TSA).

Main Results:

• No significant differences in re-hospitalization, mortality, thirst, quality of life, diuretic doses, or serum sodium levels.
• Fluid-restricted patients showed increased serum creatinine levels.
• Fluid-restricted patients also exhibited decreased serum B-type natriuretic peptide (BNP) levels and reduced body weight.

Conclusions:

• Current evidence on fluid intake in HF is limited by heterogeneity and small sample sizes.
• Liberal or restricted fluid intake strategies yield similar clinical outcomes in HF patients.
• Fluid restriction in HF may increase serum creatinine while decreasing BNP and body weight.