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Liberal fluid intake versus fluid restriction in chronic heart failure: a randomized clinical trial

Job J Herrmann1,2, Hans-Peter Brunner-La Rocca3,4, Lisette E H J M Baltussen1

  • 1Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands.

Nature Medicine
|March 30, 2025
PubMed

Insights

Fluid restriction in chronic heart failure patients did not improve health status compared to liberal fluid intake. Patients advised to restrict fluids experienced higher thirst distress without significant health benefits.

Area of Science:

  • Cardiology
  • Clinical Trials
  • Patient Outcomes

Background:

  • Fluid restriction is a common recommendation for chronic heart failure (CHF) management.
  • However, robust clinical evidence from randomized trials supporting this practice is limited.

Purpose of the Study:

  • To evaluate the impact of fluid restriction versus liberal fluid intake on health status in patients with chronic heart failure.

Main Methods:

  • A multicenter, open-label trial randomized 504 outpatients with CHF.
  • Intervention groups received advice for either liberal fluid intake or restriction (up to 1,500 ml/day).
  • The primary outcome was health status assessed by the Kansas City Cardiomyopathy Questionnaire Overall Summary Score (KCCQ-OSS) at 3 months.

Main Results:

  • No significant difference in KCCQ-OSS was observed between groups (74.0 liberal vs. 72.2 restricted; P=0.06).
  • Thirst distress was significantly higher in the fluid restriction group.
  • No differences in safety events were noted between the liberal and restricted fluid intake groups.

Conclusions:

  • The study questions the clinical benefit of routine fluid restriction in patients with chronic heart failure.
  • Liberal fluid intake appears to be a safe alternative, with potentially better patient comfort regarding thirst.

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