Normal-sodium diet compared with low-sodium diet in compensated congestive heart failure: Is sodium an old enemy or a new friend?

Department of Emergency Medicine, University of Palermo, Piazzale delle Cliniche 2, 90100 Palermo, Italy.
Clinical Science (Impact Factor: 5.6). 02/2008; 114(3):221-30. DOI: 10.1042/CS20070193
Source: PubMed


The aim of the present study was to evaluate the effects of a normal-sodium (120 mmol sodium) diet compared with a low-sodium diet (80 mmol sodium) on readmissions for CHF (congestive heart failure) during 180 days of follow-up in compensated patients with CHF. A total of 232 compensated CHF patients (88 female and 144 male; New York Heart Association class II-IV; 55-83 years of age, ejection fraction <35% and serum creatinine <2 mg/dl) were randomized into two groups: group 1 contained 118 patients (45 females and 73 males) receiving a normal-sodium diet plus oral furosemide [250-500 mg, b.i.d. (twice a day)]; and group 2 contained 114 patients (43 females and 71 males) receiving a low-sodium diet plus oral furosemide (250-500 mg, b.i.d.). The treatment was given at 30 days after discharge and for 180 days, in association with a fluid intake of 1000 ml per day. Signs of CHF, body weight, blood pressure, heart rate, laboratory parameters, ECG, echocardiogram, levels of BNP (brain natriuretic peptide) and aldosterone levels, and PRA (plasma renin activity) were examined at baseline (30 days after discharge) and after 180 days. The normal-sodium group had a significant reduction (P<0.05) in readmissions. BNP values were lower in the normal-sodium group compared with the low sodium group (685+/-255 compared with 425+/-125 pg/ml respectively; P<0.0001). Significant (P<0.0001) increases in aldosterone and PRA were observed in the low-sodium group during follow-up, whereas the normal-sodium group had a small significant reduction (P=0.039) in aldosterone levels and no significant difference in PRA. After 180 days of follow-up, aldosterone levels and PRA were significantly (P<0.0001) higher in the low-sodium group. The normal-sodium group had a lower incidence of rehospitalization during follow-up and a significant decrease in plasma BNP and aldosterone levels, and PRA. The results of the present study show that a normal-sodium diet improves outcome, and sodium depletion has detrimental renal and neurohormonal effects with worse clinical outcome in compensated CHF patients. Further studies are required to determine if this is due to a high dose of diuretic or the low-sodium diet.

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    • "ects excreting a small amount of sodium every day should be done . Indeed it is well possible that a low sodium excretion is just a marker of risk and confounding factors may have played an important role . For example excessive doses of diuretics in heart failure , cirrhotic or diabetic , or CKD patients may increase their risk of complications ( Paterna et al . , 2008 ; Ekinci et al . , 2011 ; Thomas et al . , 2011 ) . Yet , other hypotheses have been proposed to explain the U - shape relationship . The first is that a low sodium consumption is associated with a marked compensatory stimulation of the renin - angiotensin - aldosterone and of the sympathetic nervous system in order to maintain BP ( Grau"
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    Frontiers in Physiology 08/2015; 6:227. DOI:10.3389/fphys.2015.00227 · 3.53 Impact Factor
    • "interventions aimed at reducing dietary salt on mortality and cardiovascular morbidity. Three trials were in normotensives (HPT 1989 [36 mo], TOHP I 1992 [18 mo]; TOHP II 1997 [36 mo], n=3518 participants), two in hypertensives (Morgan 1978 [7-71 mo]; TONE 1998 [30 mo], n=758 participants), one in a mixed population of normo-and hypertensives (Chang 2006 [31 mo], n=1981 participants) and one in heart failure (Paterna 2008 [6.4 mo], n=232 participants). "
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