Effects of a Restricted Water Intake on Clinical and Laboratory Outcomes in Patients with Chronic Heart Failure: A Meta-Analysis - Pages 72-80
Renato De Vecchis and Andrea Paccone
Published: 25 November 2019
Abstract: In chronic heart failure patients (CHF), irrefutable evidence that documents the efficacy of the limitation in fluid consumption on major cardiovascular outcomes is so far lacking. Therefore, we performed a meta-analysis of studies that evaluated the efficacy and safety of the strategy of restricting fluid intake in the diet of CHF patients. The studies included were randomized controlled trials (RCTs) comparing CHF patients undergoing limitation in fluid consumption with patients who had free access to fluid intake. Primary outcomes were heart failure hospitalizations and all-cause mortality. Secondary outcomes were the sensation of thirst as measured by a visual analog scale, the duration of therapy with intravenous diuretics, and the serum levels of creatinine, sodium and B-type natriuretic peptide (BNP). The effect size was expressed as pooled odds ratio (OR) in the case of binary variables, and as weighted mean difference (WMD) in the case of continuous variables. Six RCTs were incorporated into the meta-analysis. Patients subjected to restricted fluid intake compared with those admitted to free fluid intake showed a similar rehospitalization rate (pooled odds ratio (OR)=1.52;95%CI: 0.67 to 3.43; p =0.32) and a similar mortality rate (pooled OR=1.55; 95% CI:0.87 to 2.75;p=0.14). Likewise, there were no differences in regards to patients' sense of thirst (weighted mean difference (WMD) =-0.7; 95% CI: -2.58 to 1.17; p= 0.46), the duration of intravenous diuretic treatment (WMD=0.17 days; 95% CI: -1.26 to 1.6 days; p =0.81), the serum creatinine levels (WMD=0.05 mg/dl; 95% CI: -0.16 to 0.26 mg/dl; p=0.12), and serum sodium levels (WMD= -0.86 mmol/L; 95% CI:-2.92 to 1.2 mmol/L; p=0.41). By contrast, serum BNP levels were significantly higher in the group with free fluid intake(WMD=223.76 pg/ml; 95% CI: 158.8 to 288.72 pg/ml; p<0.001). In CHF patients, liberal fluid consumption does not seem to exert an unfavorable impact on heart failure rehospitalizations or all-cause mortality.
Keywords: Water intake, heart failure, cardiovascular outcomes.