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Minerva Cardioangiologica 2020 Feb 20

DOI: 10.23736/S0026-4725.20.05072-0


lingua: Inglese

Effects of a restricted water intake on various clinical and laboratory outcomes in patients with heart failure: a meta-analysis of randomized controlled trials

Renato DE VECCHIS 1 , Andrea PACCONE 2, Marco DI MAIO 3

1 Medical and Polyspecialist Centre, DSB 29 “S. Gennaro dei Poveri Hospital”, Naples, Italy; 2 Department of Cardiology, University of Bari “Aldo Moro”, Bari, Italy; 3 Department of Cardiology, University of Campania “Luigi Vanvitelli”, Naples, Italy


INTRODUCTION: The guidelines of the Scientific Societies of Cardiology suggest limiting water intake in the diet as one of the non-pharmacological measures for the management of chronic heart failure. However, many patients with heart failure may suffer from severe thirst, even irrespective of a possible restricted fluid intake, and this has received relatively little attention in clinical studies. Moreover, definitive and irrefutable evidence that documents the efficacy of the limitation in water consumption on major cardiovascular outcomes is lacking. Therefore, we decided to perform a meta-analysis of studies that evaluated the efficacy and safety of the strategy of restricting water intake in the diet of patients with chronic heart failure.
EVIDENCE ACQUISITION: The studies included in the meta-analysis had to have the characteristics of randomized controlled trials that compared patients with heart failure undergoing limitation in water consumption with patients who had free access to water intake. Primary outcomes of interest were heart failure hospitalizations and all-cause mortality. Secondary outcomes of interest 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.
EVIDENCE SYNTHESIS: Six studies were judged to comply with the inclusion criteria and incorporated into the meta-analysis. Significant heterogeneity was detected for the majority of investigated outcomes. Patients subjected to restricted fluid intake compared with patients admitted to free intake of beverages showed a similar rehospitalization rate (5 studies, pooled OR=1.52; 95%CI: 0.67 to 3.43; p = 0.32) and a similar mortality rate(5 studies, 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 (4 studies, WMD =-0.7; 95% CI: -2.58 to 1.17; p = 0.46),the duration of intravenous diuretictreatment(2 studies, WMD=0.17 days; 95% CI: -1.26 to 1.6 days; p =0.81), the serum creatinine levels(5 studies, WMD=0.05 mg/dl; 95% CI: -0.16 to 0.26 mg/dl; p=0.12), and serum sodium levels(5 studies, 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 water intake(4 studies, WMD=223.76 pg/ml ; 95% CI: 158.8 to 288.72 pg/ml; p<0.001).
CONCLUSIONS: In patients with heart failure, liberal fluid consumption does not seem to exert an unfavorable impact on heart failure rehospitalizations or all-cause mortality. Considering the heterogeneity of the included studies and their quite exiguous sample sizes, larger randomized controlled trials would be warranted in the future in order to achieve definitive confirmation of the present findings. These findings substantially disavow any useful role of water intake restriction as a non-pharmacological measure to be adopted in heart failure management.

KEY WORDS: Water intake; Heart failure; Cardiovascular outcomes

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