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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Available from: Filippo Maria Sarullo
    • "Additionally, a meta-analysis (subsequently retracted because of concerns related to the validity of the data)[36,37]of these and other trials (six RCTs, n ¼ 2747 patients) conducted by the same research group concluded that compared with a normal sodium diet (2800 mg/day), a low-sodium diet (1800 mg/day) significantly increased all-cause mortality[RCTs testing the effects of sodium restriction in heart failure regarding the severity of heart failure in the study population, employed clinical and therapeutic approaches, tested levels of sodium restriction, methods for monitoring adherence to the sodium intake recommendations[13], trial size, and length of follow-up, making it challenging to compare data and draw definitive conclusions. Additionally, only a few RCTs have included clinical outcomes as a primary endpoint: of those, one was unpowered to test the association between reduced sodium intake and outcomes[25], and three were conducted in the context of an aggressive diuretic treatment and fluid restriction171819. Thus, the effects of a low-sodium diet on clinical outcomes in patients with heart failure remain unclear.Fluid intake was reduced in the IG compared with CG. "
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    ABSTRACT: Purpose of review: Recognizing the relevance of sodium balance in heart failure, it has been presumed that patients with heart failure benefit from a low-sodium diet, though its efficacy and safety are unclear. The purpose of this review is to provide insight into the currently available evidence base for the effects of dietary sodium restriction in patients with chronic heart failure. Recent findings: There has been an increasing body of evidence on the effects of sodium restriction in heart failure; however, both observational and experimental studies have shown mixed results. Recent randomized controlled trial data has even suggested that sodium restriction may have detrimental effects in patients with heart failure. Only a few randomized controlled trials have included clinical outcomes as a primary endpoint. These have been either unpowered to test the association between reduced sodium intake and outcomes, or conducted in the context of an aggressive diuretic treatment and fluid restriction. Summary: The effects of a low-sodium diet on clinical outcomes in patients with heart failure remain unclear. Ongoing research into the effects of lowering sodium for patients with chronic or acute heart failure will shed light on the importance of holistic self-care and dietary strategies in heart failure.
    No preview · Article · Nov 2015 · Current Opinion in Cardiology
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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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    ABSTRACT: Among the various strategies to reduce the incidence of non-communicable diseases reduction of sodium intake in the general population has been recognized as one of the most cost-effective means because of its potential impact on the development of hypertension and cardiovascular diseases. Yet, this strategic health recommendation of the WHO and many other international organizations is far from being universally accepted. Indeed, there are still several unresolved scientific and epidemiological questions that maintain an ongoing debate. Thus what is the adequate low level of sodium intake to recommend to the general population and whether national strategies should be oriented to the overall population or only to higher risk fractions of the population such as salt-sensitive patients are still discussed. In this paper, we shall review the recent results of the literature regarding salt, blood pressure and cardiovascular risk and we present the recommendations recently proposed by a group of experts of Switzerland. The propositions of the participating medical societies are to encourage national health authorities to continue their discussion with the food industry in order to reduce the sodium intake of food products with a target of mean salt intake of 5-6 grams per day in the population. Moreover, all initiatives to increase the information on the effect of salt on health and on the salt content of food are supported.
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    • "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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    ABSTRACT: Although meta-analyses of randomized controlled trials (RCTs) of salt reduction report a reduction in the level of blood pressure (BP), the effect of reduced dietary salt on cardiovascular disease (CVD) events remains unclear. We searched for RCTs with follow-up of at least 6 months that compared dietary salt reduction (restricted salt dietary intervention or advice to reduce salt intake) to control/no intervention in adults, and reported mortality or CVD morbidity data. Outcomes were pooled at end of trial or longest follow-up point. Seven studies were identified: three in normotensives, two in hypertensives, one in a mixed population of normo- and hypertensives and one in heart failure. Salt reduction was associated with reductions in urinary salt excretion of between 27 and 39 mmol/24 h and reductions in systolic BP between 1 and 4 mm Hg. Relative risks (RRs) for all-cause mortality in normotensives (longest follow-up-RR: 0.90, 95% confidence interval (CI): 0.58-1.40, 79 deaths) and hypertensives (longest follow-up RR 0.96, 0.83-1.11, 565 deaths) showed no strong evidence of any effect of salt reduction CVD morbidity in people with normal BP (longest follow-up: RR 0.71, 0.42-1.20, 200 events) and raised BP at baseline (end of trial: RR 0.84, 0.57-1.23, 93 events) also showed no strong evidence of benefit. Salt restriction increased the risk of all-cause mortality in those with heart failure (end of trial RR 2.59, 1.04-6.44, 21 deaths).We found no information on participant's health-related quality of life. Despite collating more event data than previous systematic reviews of RCTs (665 deaths in some 6,250 participants) there is still insufficient power to exclude clinically important effects of reduced dietary salt on mortality or CVD morbidity. Our estimates of benefits from dietary salt restriction are consistent with the predicted small effects on clinical events attributable to the small BP reduction achieved.
    No preview · Article · Aug 2011 · American Journal of Hypertension
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