Effect of Fluid Restriction in Heart Failure: A Meta-Analysis of Randomized Controlled Trials

Area of Science:

• Cardiology
• Nephrology
• Critical Care Medicine

Background:

• Fluid restriction is a common recommendation for heart failure (HF) patients to manage volume overload.
• However, the clinical effectiveness and safety of fluid restriction in HF remain uncertain.
• Existing evidence lacks a comprehensive synthesis of its impact on key patient outcomes.

Purpose of the Study:

• To conduct a meta-analysis comparing the efficacy and safety of fluid restriction versus liberal fluid intake in adult patients with heart failure.
• To evaluate the impact on re-hospitalization, mortality, weight, thirst, quality of life, diuretic use, and serum biomarkers.

Main Methods:

• Systematic literature search of PubMed, Scopus, and Cochrane CENTRAL up to May 2025.
• Inclusion of ten randomized controlled trials (RCTs) involving 1465 participants.
• Meta-analysis of outcomes including re-hospitalization, mortality, weight, thirst, quality of life, intravenous diuretic use, and serum biomarkers (sodium, creatinine, BNP).

Main Results:

• Fluid restriction showed a trend towards reducing re-hospitalization (RR 0.71) and mortality (RR 0.71), but these did not reach statistical significance.
• No significant differences were found in thirst, quality of life, intravenous diuretic use, serum sodium, creatinine, or brain natriuretic peptide levels.
• Subgroup analysis indicated liberal fluid intake may reduce creatinine in chronic compensated HF but not in acute decompensated HF.

Conclusions:

• Current evidence suggests fluid restriction does not significantly improve major outcomes in heart failure patients.
• Liberal fluid intake appears to be safe and may offer benefits in specific HF subgroups.
• Individualized fluid management strategies tailored to patient status are recommended for optimal heart failure care.