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

被引：3

作者：

Herrmann, Job J. ^{[1
,2
]}

Brunner-La Rocca, Hans-Peter ^{[3
,4
]}

Baltussen, Lisette E. H. J. M. ^{[1
]}

Beckers-Wesche, Fabienne ^{[3
]}

Bekkers, Sebastiaan C. A. M. ^{[5
]}

Bellersen, Louise ^{[1
]}

van Eck, J. W. Martijn ^{[6
]}

Hassing, H. Carlijne ^{[1
]}

Jaarsma, Tiny ^{[7
,8
]}

Linssen, Gerard C. M. ^{[9
]}

Pisters, Ron ^{[10
]}

Sanders-van Wijk, Sandra ^{[11
]}

Verdijk, Marjolein H. I. ^{[1
]}

Handoko, M. Louis ^{[8
]}

van der Meer, Peter ^{[12
]}

Verbrugge, Frederik H. ^{[13
,14
]}

Januzzi Jr, James L. ^{[15
]}

Bayes-Genis, Antoni ^{[16
]}

Nieuwlaat, Robby ^{[17
]}

Rodwell, Laura ^{[18
]}

Gommans, D. H. Frank ^{[1
,19
]}

van Kimmenade, Roland R. J. ^{[1
]}

机构：

[1] Radboud Univ Nijmegen, Dept Cardiol, Med Ctr, Nijmegen, Netherlands

[2] Netherlands Heart Inst, Utrecht, Netherlands

[3] Maastricht Univ, Med Ctr, Dept Cardiol, Maastricht, Netherlands

[4] Maastricht Univ, Cardiovasc Res Inst Maastricht CARIM, Maastricht, Netherlands

[5] Bernhoven Hosp, Dept Cardiol, Uden, Netherlands

[6] Jeroen Bosch Hosp, Dept Cardiol, Shertogenbosch, Netherlands

[7] Linkoping Univ, Dept Hlth Med & Caring Sci, Linkoping, Sweden

[8] Univ Med Ctr Utrecht, Dept Cardiol, Utrecht, Netherlands

[9] Hosp Grp Twente, Dept Cardiol, Almelo Hengelo, Netherlands

[10] Rijnstate Hosp, Dept Cardiol, Arnhem, Netherlands

[11] Zuyderland Med Ctr, Dept Cardiol, Geleen, Netherlands

[12] Univ Groningen, Univ Med Ctr Groningen, Dept Cardiol, Groningen, Netherlands

[13] Univ Hosp Brussels, Ctr Cardiovasc Dis, Jette, Belgium

[14] Vrije Univ Brussel, Fac Med & Pharm, Brussels, Belgium

[15] Harvard Med Sch, Boston, MA USA

[16] Hosp Univ Germans Trias i Pujol, Cardiol Serv, CIBERVC, Badalona, Spain

[17] McMaster Univ, Dept Hlth Res Methods Evidence & Impact, Hamilton, ON, Canada

[18] Radboud Univ Nijmegen, IQ Hlth Dept, Med Ctr, Nijmegen, Netherlands

[19] Maxima Med Ctr, Dept Cardiol, Veldhoven, Netherlands

来源：

NATURE MEDICINE | 2025年 / 31卷 / 06期

关键词：

QUALITY-OF-LIFE; CITY CARDIOMYOPATHY QUESTIONNAIRE; PHYSICAL CAPACITY; THIRST; OUTCOMES; METAANALYSIS; DISTRESS;

D O I：

10.1038/s41591-025-03628-4

中图分类号：

Q5 [生物化学]; Q7 [分子生物学];

学科分类号：

071010 ; 081704 ;

摘要：

Fluid restriction is frequently recommended to patients with chronic heart failure, but randomized clinical trials assessing the effects of fluid restriction remain scarce. In this multicenter open-label trial, outpatients with chronic heart failure were randomized to receiving advice for liberal fluid intake versus receiving advice for fluid restriction, up to 1,500 ml per day of fluid intake. The primary outcome of the trial was health status after 3 months, as assessed by the Kansas City Cardiomyopathy Questionnaire Overall Summary Score (KCCQ-OSS). Secondary outcomes included thirst distress and safety events. Among 504 randomized patients (67.3% male), the KCCQ-OSS after 3 months was 74.0 in the liberal fluid intake group versus 72.2 in the fluid restriction group, with a mean difference after adjustment for baseline scores of 2.17 (95% confidence interval -0.06 to 4.39; P = 0.06), indicating that the primary outcome was not met. Thirst distress was higher in the fluid restriction group and no differences were observed for safety events between the two groups. These findings question the benefit of fluid restriction in chronic heart failure. ClinicalTrials.gov registration: NCT04551729.

引用

页码：2062 / 2068

页数：20

共 29 条

[1] Interpreting Population Mean Treatment Effects in the Kansas City Cardiomyopathy Questionnaire [J].

Jawad, Mohammad Abdel ;

Jones, Philip G. ;

Arnold, Suzanne V. ;

Cohen, David J. ;

Sherrod, Charles F. ;

Khan, Mirza S. ;

Ikemura, Nobuhiro ;

Chan, Paul S. ;

Spertus, John A. .

JAMA CARDIOLOGY, 2025, 10 (01) :32-40

[2] A Randomized Controlled Pilot Study of Outcomes of Strict Allowance of Fluid Therapy in Hyponatremic Heart Failure (SALT-HF) [J].

Albert, Nancy M. ;

Nutter, Benjamin ;

Forney, Jennifer ;

Slifcak, Ellen ;

Tang, W. H. Wilson .

JOURNAL OF CARDIAC FAILURE, 2013, 19 (01) :1-9

[3]

DeVecchis R, 2016, HERZ, V41, P63, DOI 10.1007/s00059-015-4345-9

[4] Heart rate reduction with ivabradine and health related quality of life in patients with chronic heart failure: results from the SHIFT study [J].

Ekman, Inger ;

Chassany, Olivier ;

Komajda, Michel ;

Boehm, Michael ;

Borer, Jeffrey S. ;

Ford, Ian ;

Tavazzi, Luigi ;

Swedberg, Karl .

EUROPEAN HEART JOURNAL, 2011, 32 (19) :2395-2404

[5] Thirst and factors associated with frequent thirst in patients with heart failure in Spain [J].

Eng, Sanna Hagelberg ;

Jaarsma, Tiny ;

Lupon, Josep ;

Gonzalez, Beatriz ;

Ehrlin, Jenny ;

Diaz, Violeta ;

Bayes-Genis, Antoni ;

Waldreus, Nana .

HEART & LUNG, 2021, 50 (01) :86-91

[6] Development and evaluation of the Kansas City Cardiomyopathy Questionnaire: A new health status measure for heart failure [J].

Green, CP ;

Porter, CB ;

Bresnahan, DR ;

Spertus, JA .

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2000, 35 (05) :1245-1255

[7] Thirst distress in outpatients with heart failure in a Mediterranean zone of Spain [J].

Hagelberg Eng, Sanna ;

Waldreus, Nana ;

Gonzalez, Beatriz ;

Ehrlin, Jenny ;

Diaz, Violeta ;

Rivas, Carmen ;

Velayos, Patricia ;

Puertas, Maria ;

Ros, Alba ;

Martin, Paula ;

Lupon, Josep ;

Bayes-Genis, Antoni ;

Jaarsma, Tiny .

ESC HEART FAILURE, 2021, 8 (04) :2492-2501

[8] 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines [J].

Heidenreich, Paul A. ;

Bozkurt, Biykem ;

Aguilar, David ;

Allen, Larry A. ;

Byun, Joni J. ;

Colvin, Monica M. ;

Deswal, Anita ;

Drazner, Mark H. ;

Dunlay, Shannon M. ;

Evers, Linda R. ;

Fang, James C. ;

Fedson, Savitri E. ;

Fonarow, Gregg C. ;

Hayek, Salim S. ;

Hernandez, Adrian F. ;

Khazanie, Prateeti ;

Kittleson, Michelle M. ;

Lee, Christopher S. ;

Link, Mark S. ;

Milano, Carmelo A. ;

Nnacheta, Lorraine C. ;

Sandhu, Alexander T. ;

Stevenson, Lynne Warner ;

Vardeny, Orly ;

Vest, Amanda R. ;

Yancy, Clyde W. .

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2022, 79 (17) :E253-E421

[9] Fluid REStriction in Heart Failure vs Liberal Fluid UPtake: Rationale and Design of the Randomized FRESH-UP Study [J].

Herrmann, Job J. ;

Beckers-Wesche, Fabienne ;

Baltussen, Lisette E. H. J. M. ;

Verdijk, Marjolein H., I ;

Bellersen, Louise ;

Brunner-la Rocca, Hans-Peter ;

Jaarsma, Tiny ;

Pisters, Ron ;

Sanders-van Wijk, Sandra ;

Rodwell, Laura ;

Van Royen, Niels ;

Gommans, D. H. Frank ;

Van Kimmenade, Roland R. J. .

JOURNAL OF CARDIAC FAILURE, 2022, 28 (10) :1522-1530

[10] Liberal versus restricted fluid prescription in stabilised patients with chronic heart failure:: Result of a randomised cross-over study of the effects on health-related quality of life, physical capacity, thirst and morbidity [J].

Holst, Marie ;

Stromberg, Anna ;

Lindholm, Maud ;

Willenheimer, Ronnie .

SCANDINAVIAN CARDIOVASCULAR JOURNAL, 2008, 42 (05) :316-322

← 1 2 3 →