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

被引：0

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

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 30 条

[1] Eng S.H., Et al., Thirst and factors associated with frequent thirst in patients with heart failure in Spain, Heart Lung, 50, pp. 86-91, (2021)
[2] van der Wal M.H.L., Waldreus N., Jaarsma T., Kato N.P., Thirst in patients with heart failure in Sweden, the Netherlands, and Japan, J. Cardiovasc. Nurs, 35, pp. 19-25, (2020)
[3] van der Wal M.H.L., Jaarsma T., Jenneboer L.C., Linssen G.C.M., Thirst in stable heart failure patients
[4] time to reconsider fluid restriction and prescribed diuretics, ESC Heart Fail, 9, pp. 2181-2188, (2022)
[5] Vazir A., Et al., Decongestion strategies in patients presenting with acutely decompensated heart failure: a worldwide survey among physicians, Eur. J. Heart Fail, 25, pp. 1555-1570, (2023)
[6] Hoog L., Stromberg A., Waldreus N., Nymark C., A national survey of healthcare professional’s clinical practice on fluid intake in patients with heart failure. Abstract, Eur. J. Heart Fail., 26, pp. 3-643, (2024)
[7] De Vecchis R., Baldi C., Cioppa C., Giasi A., Fusco A., Effects of limiting fluid intake on clinical and laboratory outcomes in patients with heart failure. Results of a meta-analysis of randomized controlled trials, Herz, 41, pp. 63-75, (2016)
[8] Li Y., Fu B., Qian X., Liberal versus restricted fluid administration in heart failure patients. A systematic review and meta-analysis of randomized trials, Int. Heart J, 56, pp. 192-195, (2015)
[9] Albert N.M., Nutter B., Forney J., Slifcak E., Tang W.H., A randomized controlled pilot study of outcomes of strict allowance of fluid therapy in hyponatremic heart failure (SALT-HF), J. Card. Fail, 19, pp. 1-9, (2013)
[10] Holst M., Stromberg A., Lindholm M., Willenheimer R., 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, Scand. Cardiovasc. J, 42, pp. 316-322, (2008)

← 1 2 3 →