Sodium Restriction In Patients Research Articles

Sodium restriction in patients with chronic heart failure and reduced ejection fraction: A randomized controlled trial.

Sodium restriction is recommended for patients with heart failure (HF) despite the lack of solid clinical evidence from randomized controlled trials. Whether or not sodium restrictions provide beneficial cardiac effects is not known. The present study is a randomized, double-blind, controlled trial of stable HF patients with ejection fraction ≤ 40%. Patients were allocated to sodium restriction (2 g of sodium/day) vs. control (3 g of sodium/day). The primary outcome was change in N-terminal pro-B-type natriuretic peptide (NT-proBNP) at 20 weeks. Secondary outcomes included quality of life and adverse safety events (HF readmission, blood pressure or electrolyte abnormalities). Seventy patients were enrolled. Median baseline sodium consumption was 3268 (2225-4537) mg/day. Adherence to the intervention based on 24-hour urinary sodium was 32%. NT-proBNP and quality of life did not significantly change between groups (p > 0.05 for both). Adverse safety events were not significantly different between the arms (p > 0.6 for all). In the per protocol analysis, patients who achieved a sodium intake < 2500 mg/day at the intervention conclusion showed improvements in NT-proBNP levels (between-group difference: -55%, 95% confidence interval -27 to -73%; p = 0.002) and quality of life (between-group difference: -11 ± 5 points; p = 0.04). Blood pressure decreased in patients with lower sodium intake (between-group difference: -9 ± 5 mmHg; p = 0.05) without significant differences in symptomatic hypotension or other safety events (p > 0.3 for all). Adherence assessed by 24-hour natriuresis and by the nutritionist was poor. The group allocated to sodium restriction did not show improvement in NT-proBNP. However, patients who achieved a sodium intake < 2500 mg/day appeared to have improvements in NT-proBNP and quality of life without any adverse safety signals. gov Identifier: NCT03351283.

Efficacy of an Educational Intervention for Sodium Restriction in Patients with Hypertension: A Randomized Controlled Trial

There is sound evidence showing the efficacy of non-pharmacological interventions in lowering blood pressure (BP); however, adherence is usually poor. Interventions to induce behavioral changes aim to improve the ability to read labels, choose foods, and eat low-sodium meals, reinforcing adherence to sodium restriction. In this randomized parallel-controlled trial, we assessed the effectiveness of an educational intervention using the Dietary Sodium Restriction Questionnaire (DSRQ) scores. A follow-up period of 6 months was conducted. Participants were randomized into (1) an educational intervention provided by a registered dietitian on individual visits and dietary planning; (2) a control group with the usual care and dietary recommendations. Patients underwent 24-h ambulatory BP monitoring, 12-h fasting blood tests, spot urine collection, and assessment using DSRQ. We randomized 120 participants (67.5% women and 68.3% Caucasians), and 25 participants were lost to follow-up. The 24-h sodium urinary excretion changed in the control (Δ −1610 mg/day; 95% confidence interval [CI] −1800 to −1410) and intervention groups (Δ −1670 mg/day; 95% CI −1800 to −1450) over time. There was no significant difference in the 24-h estimated sodium between groups. In hypertensive patients, DSRQ-based educational intervention is effective for improving the ability to detect and overcome obstacles to a low-sodium restriction diet but is as effective as dietary recommendations for lowering sodium.

Letter by Qiu and Du Regarding Article, "Sodium Restriction in Patients With Heart Failure: A Systematic Review and Meta-Analysis of Randomized Clinical Trials".

Letter by Qiu and Du Regarding Article, "Sodium Restriction in Patients With Heart Failure: A Systematic Review and Meta-Analysis of Randomized Clinical Trials".

Response by Colin-Ramirez et al to Letter Regarding Article, "Sodium Restriction in Patients With Heart Failure: A Systematic Review and Meta-Analysis of Randomized Clinical Trials".

Response by Colin-Ramirez et al to Letter Regarding Article, "Sodium Restriction in Patients With Heart Failure: A Systematic Review and Meta-Analysis of Randomized Clinical Trials".

Sodium Restriction in Patients With Heart Failure: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.

Sodium restriction is a nonpharmacologic treatment suggested by practice guidelines for the management of patients with heart failure (HF). In this study, we synthesized the data from randomized controlled trials (RCTs) evaluating the effects of sodium restriction on clinical outcomes in patients with HF. In this aggregate data meta-analysis, Cochrane Central, MEDLINE (Medical Literature Analysis and Retrieval System Online), Embase Ovid, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) Plus databases were searched up to April 2, 2022. RCTs were included if they investigated the effects of sodium/salt restriction as compared to no restriction on clinical outcomes in patients with HF. Outcomes of interest included mortality, hospitalization, change in New York Heart Association functional class, and quality of life (QoL). Seventeen RCTs were identified (834 and 871 patients in intervention and control groups, respectively). Sodium restriction did not reduce the risk of all-cause death (odds ratio, 0.95 [95% CI, 0.58-1.58]), hospitalization (odds ratio, 0.84 [95% CI, 0.62-1.13]), or the composite of death/hospitalization (odds ratio, 0.88 [95% CI, 0.63-1.23]). The results were similar in different subgroups, except for the numerically lower risk of death with reduced sodium intake reported in RCTs with dietary sodium at the 2000 to 3000 mg/d range as opposed to <2000 mg/d (and in RCTs with versus without fluid restriction as a co-intervention). Among RCTs reporting New York Heart Association change, 2 RCTs (which accounted for two-thirds of the data) showed improvement in New York Heart Association class with sodium restriction. Substantial heterogeneity existed for QoL: 6 RCTs showed improvement of QoL and 4 RCTs showed no improvement of sodium restriction on QoL. In a meta-analysis of RCTs, sodium restriction was not associated with fewer deaths or hospitalizations in patients with HF. Dietary sodium restriction may be associated with improvements in symptoms and QoL.

Abstract 15681: Impact of Dietary Sodium Restriction on Heart Failure Outcomes: A Systematic Review and Meta-Analysis

Introduction: Although heart failure (HF) guidelines emphasized dietary sodium restriction, the recommendation was based on limited evidence. We analyzed the impact of dietary sodium restriction on HF outcomes and quality of life (QoL) by systematically reviewing the available literature to-date. Methods: MEDLINE and SCOPUS were queried from inception till April 2022 for randomized controlled trials (RCTs) and observational studies with sodium restriction (≤1500-3000mg) as an intervention/comparator and assessing its impact (or association) on HF outcomes. Data about HF-related hospitalizations, all-cause mortality and QoL (via the Kansas City Cardiomyopathy Questionnaire) was extracted, pooled and analyzed. Forest plots were created based on random effects model. Results: Twelve studies (n= 4637 patients) were included in our analysis with a median follow-up time of 6 months. The pooled analysis demonstrated no difference in HF hospitalizations between the sodium-restricted and unrestricted groups (OR = 1.30 [0.81-2.10] P&lt;0.28) (Figure 1a). However, a significantly higher risk of all-cause mortality was observed associated with sodium-restriction (OR = 1.68, 95% CI: 1.26-2.24, P&lt; 0.0004) (Figure 1b). Dietary sodium restriction was not associated with QoL (mean difference = 0.14, 95% CI: -0.07-0.35, P&lt; 0.18). (Figure 1c). Conclusions: Our observations suggest that sodium restriction in patients with HF may not improve QoL or reduce hospitalizations, but is associated with increased risk of mortality.

A LITERATURE REVIEW: LOW SODIUM RESTRICTION OF PATIENTS WITH HEART FAILURE ON HOSPITAL READMISSION

&lt;p&gt;Sodium restriction effect on hospital readmission in patients with heart failure (HF) has been questioned for decades. Readmission related to low sodium intake recommendations should be changed as well as mortality. A literature review is needed to summarize the effect of low sodium, especially on readmission and mortality. This literature review aimed to summarize the prevalence of hospital readmission and mortality regarding low sodium intake in patients with HF. The searching process involved four databases; MEDLINE, Embase, EBSCO Health, Cochrane was explored for experimental studies of sodium restriction. Of 77 screened citations from 2000 to 2019 invested in patients with HF, four studies were included. Four studies from four databases were included and explained and it was found that hospital readmission was the outcome of implementing sodium restriction in patients with HF. Low sodium restriction (800 mg – 1800 mg/day) results in higher hospital readmission. Moreover, 1800 mg/day of sodium was followed by higher mortality and higher sudden death in patients with HF. Low sodium restriction did not lower hospital readmission as well as mortality of patients with HF. This article provides the reason, effect, and amount of sodium restriction in patients with HF. The recommendation from this literature review is low sodium restriction has no beneficial effect on readmission and mortality in HF conditions.&lt;/p&gt;

Do Nutritional Interventions Improve the Outcomes of Patients with Cirrhosis and Ascites: A Systematic Review of Randomized Trials.

Ascites is a common, morbid complication of cirrhosis. Nutritional interventions such as sodium-restriction and high-protein diet are considered standard of care. However, their evidence base is limited. We performed a systematic review of randomized trials of nutritional interventions for ascites. Increasing consumption of calories and protein alone was ineffective. Studies reached contradictory conclusions regarding sodium restriction in patients taking combination diuretics. Intravenous amino acid infusion alone did not improve outcomes, peripheral parenteral nutrition did not improve outcomes except alone but reduced mortality in conjunction with branched-chain amino acid evening snack. Patients may benefit from sodium restriction and a protein-rich evening snack. Future trials should prioritize standardizing nutritional targets and tailoring interventions to the specific needs of patients including the socioeconomic factors impacting adherence.

A Self-management Approach for Dietary Sodium Restriction in Patients With CKD: A Randomized Controlled Trial

Patients with chronic kidney disease (CKD) are particularly sensitive to dietary sodium. We evaluated a self-management approach for dietary sodium restriction in patients with CKD. Randomized controlled trial. Nephrology outpatient clinics in 4 Dutch hospitals. 99 adults with CKD stages 1 to 4 or a functioning (estimated glomerular filtration rate≥25mL/min/1.73m2) kidney transplant, hypertension, and sodium intake>130mmol/d. Routine care was compared with routine care plus a web-based self-management intervention including individual e-coaching and group meetings implemented over a 3-month intervention period, followed by e-coaching over a 6-month maintenance period. Primary outcomes were sodium excretion after the 3-month intervention and after the 6-month maintenance period. Secondary outcomes were blood pressure, proteinuria, costs, quality of life, self-management skills, and barriers and facilitators for implementation. Baseline estimated glomerular filtration rate was 55.0±22.0mL/min/1.73m2. During the intervention period, sodium excretion decreased in the intervention group from 188±8 (SE) to 148±8mmol/d (P<0.001), but did not change significantly in the control group. At 3 months, mean sodium excretion was 24.8 (95% CI, 0.1-49.6) mmol/d lower in the intervention group (P=0.049). At 3 months, systolic blood pressure (SBP) decreased in the intervention group from 140±3 to 132±3mm Hg (P<0.001), but was unchanged in the control group. Mean difference in SBP across groups was-4.7 (95% CI,-10.7 to 1.3) mm Hg (P=0.1). During the maintenance phase, sodium excretion increased in the intervention group, but remained lower than at baseline at 160±8mmol/d (P=0.01), while it decreased in the control group from 174±9 at the end of the intervention period to 154±9mmol/d (P=0.001). Consequently, no difference in sodium excretion between groups was observed after the maintenance phase. There was no difference in SBP between groups after the maintenance phase. Limited power, postrandomization loss to follow-up, Hawthorne effect, lack of dietary data, short-term follow-up. A coaching intervention reduced sodium intake at 3 months. Efficacy during the maintenance phase was diminished, possibly due to inadvertent adoption of the intervention by the control group. Grant funding from the Netherlands Organization for Health Research and Development and the Dutch Kidney Foundation. Registered at ClinicalTrials.gov with study number NCT02132013.

Evidence related to sodium restriction in patients with heart failure.

to analyze the scientific production about sodium restriction in patients with heart failure. integrative literature review from articles published from 2007 to 2017, located in the CINAHL and Scopus databases. thirteen studies were analyzed. Sodium intake restriction was associated with lower unfavorable clinical outcomes in patients with marked symptomatology. The 24-hour urine sodium dosage was the main tool to assess adherence to the low sodium diet. based on the studies included in this review, in symptomatic patients, dietary sodium restriction should be encouraged in clinical practice as a protective measure for health. However, in asymptomatic patients, it should be well studied.

Effects of dietary counseling on sodium restriction in patients with chronic kidney disease on hemodialysis: A randomized clinical trial.

Reducing dietary sodium has the potential to benefit patients with chronic kidney disease on hemodialysis (HD). This study was aimed to evaluate the effects of dietary counseling on sodium restriction and its relationship with clinical, dietary, and quality of life parameters in patients on HD treatment. This study was designed as a randomized clinical trial. The study included 87 patients on HD, divided into intervention (n = 47) and control (n = 40) groups. Anthropometric, clinical, sodium intake, and quality of life data were evaluated in both groups at four-time points: baseline (T0), 90 days (T3), 180 days (T6), and 365 days (T12). The intervention group received dietary counseling at the beginning and throughout the study. There were no between-group differences regarding anthropometric, clinical, and quality of life data at any of the time points. The mean age was 59 ± 14 years, and most of the patients were men (61%) and had hypertension (90%). Total sodium (g) and processed meat (mg sodium) intake significantly decreased in both groups [intervention: T0 = 3.5 (2.3-4.7); T12 = 2.0 (0.7-2.5); P <0.0001; control: T0 = 3 (1.5-4.9); T12 = 2.0 (0.8-3.3); P = 0.001; and intervention: T0 = 78 (25-196); T12 = 21 (0-78); P = 0.003; control: T0 = 97 (31-406); T12 = 44 (0-152); P = 0.004, respectively] . There was a significant decrease in the consumption of packaged seasonings (mg sodium) [T0 = 130 (0-854); T12 = 0 (0-0); P = 0.015] and instant noodles [T0 = 19 (0-91); T12 = 0 (0-0); P = 0.017] in the intervention group. Dietary counseling was effective in changing dietary habits. In both groups, there was a reduction in total sodium intake, which was greater in the intervention group. Moreover, a decrease in the intake of salty foods, such as packaged seasonings and instant noodles, was only observed in the intervention group.

Development and Validation of a New Tool to Assess Burden of Dietary Sodium Restriction in Patients with Chronic Heart Failure: The BIRD Questionnaire.

(1) Background: Burden scales are useful in estimating the impact of interventions from patients’ perspectives. This is overlooked in sodium diet/heart failure (HF). The aim of this study is to develop and validate a specific tool to assess the burden associated with low-sodium diets in HF: the Burden scale In Restricted Diets (BIRD). (2) Methods: Based on the literature and reports from patients, 14 candidate items were identified for the following dietary-related domains: organization, pleasure, leisure, social life, vitality, and self-rated health. The validation study was conducted prospectively. The questionnaire was refined via item reduction according to inter-item correlations and exploratory factor analysis. Internal consistency was determined using Cronbach’s alpha (Cα) and convergent validity by assessing correlations between BIRD and the health-related quality of life (HRQoL) Minnesota Living with HF questionnaire (MLHF). (3) Results: Of the 152 invited patients, 96 (63%) returned the questionnaire. The median score was 6.5 (IQR 2.0–14.0). The results showed good acceptability (non-response rates/item from 2.0% to 12.1%), an excellent internal consistency (Cα = 0.903) and a good convergent validity (rhos = 0.37 (physical), 0.4 (mental), and 0.45 (global); all p < 0.05). (4) Conclusions: BIRD demonstrates good psychometric properties and is useful to quantify the burden associated with sodium restriction. It may help optimize dietary interventions and improve the overall management of patients with HF.

Academy of Nutrition and Dietetics Evidence-Based Practice Guideline for the Management of Heart Failure in Adults

Academy of Nutrition and Dietetics Evidence-Based Practice Guideline for the Management of Heart Failure in Adults

Updated Canadian Expert Consensus on Assessing Risk of Disease Progression and Pharmacological Management of Autosomal Dominant Polycystic Kidney Disease.

Purpose:The purpose of this article is to update the previously published consensus recommendations from March 2017 discussing the optimal management of adult patients with autosomal dominant polycystic kidney disease (ADPKD). This document focuses on recent developments in genetic testing, renal imaging, assessment of risk regarding disease progression, and pharmacological treatment options for ADPKD.Sources of information:Published literature was searched in PubMed, the Cochrane Library, and Google Scholar to identify the latest evidence related to the treatment and management of ADPKD.Methods:All pertinent articles were reviewed by the authors to determine if a new recommendation was required, or if the previous recommendation needed updating. The consensus recommendations were developed by the authors based on discussion and review of the evidence.Key findings:The genetics of ADPKD are becoming more complex with the identification of new and rarer genetic variants such as GANAB. Magnetic resonance imaging (MRI) and computed tomography (CT) continue to be the main imaging modalities used to evaluate ADPKD. Total kidney volume (TKV) continues to be the most validated and most used measure to assess disease progression. Since the publication of the previous consensus recommendations, the use of the Mayo Clinic Classification for prognostication purposes has been validated in patients with class 1 ADPKD. Recent evidence supports the benefits of a low-osmolar diet and dietary sodium restriction in patients with ADPKD. Evidence from the Replicating Evidence of Preserved Renal Function: an Investigation of Tolvaptan Safety and Efficacy in ADPKD (REPRISE) trial supports the use of ADH (antidiuretic hormone) receptor antagonism in patients with ADPKD 18 to 55 years of age with eGFR (estimated glomerular filtration rate) of 25 to 65 mL/min/1.73 m2 or 56 to 65 years of age with eGFR of 25 to 44 mL/min/1.73 m2 with historical evidence of a decline in eGFR >2.0 mL/min/1.73 m2/year.Limitations:Available literature was limited to English language publications and to publications indexed in PubMed, the Cochrane Library, and Google Scholar.Implications:Advances in the assessment of the risk of disease progression include the validation of the Mayo Clinic Classification for patients with class 1 ADPKD. Advances in the pharmacological management of ADPKD include the expansion of the use of ADH receptor antagonism in patients 18 to 55 years of age with eGFR of 25 to 65 mL/min/1.73 m2 or 56 to 65 years of age with eGFR of 25 to 44 mL/min/1.73 m2 with historical evidence of a decline in eGFR >2.0 mL/min/1.73 m2/year, as per the results of the REPRISE study.

The effectiveness of an educational intervention for sodium restriction in patients with hypertension: study protocol for a randomized controlled trial

BackgroundThe effectiveness of nonpharmacological interventions in blood pressure reduction has been evidenced by several studies. Nevertheless, as adherence to a low-sodium diet is poor, interventions regarding habit changing should be of a motivational nature in order to develop the ability of overcoming obstacles regarding sodium-restriction behavior.The present study aims to describe the protocol and randomization of a clinical trial design in order to evaluate the effectiveness of an educational intervention based on Dietary Sodium Restriction Questionnaire (DSRQ) scores. The effectiveness measures are the DSRQ score variation and reduction in urinary sodium values from baseline to after 2 and 6 months.Methods/designThis parallel, randomized clinical trial will include 120 participants, recruited and randomized as follows: 60 of them to be allocated to a sodium-restriction educational intervention group whose results are based on the DSRQ application; and the other 60 allocated to a control group with usual care. Educational orientation and usual care sessions will be conducted once a month for a period of 6 months. Both spot urine collection – estimating sodium intake – and the DSRQ will be applied at the baseline, in the eighth week and at the end of the follow-up. There will also be blood collection and 24-h ambulatory blood pressure monitoring (ABPM) at the beginning and end of the follow-up. Anthropometric measurements, blood pressure measurement and 24-h food recall will be collected during follow-up.DiscussionThe study “The effectiveness of an educational intervention to sodium restriction in patients with hypertension” is based on the results of the DSRQ application, whose objective is to evaluate aspects related to nonadherence to the recommendation of a low-sodium diet, identifying adherence barriers and facilitators, contributing to the planning of interventions for improving the adoption of a low-sodium diet and, consequently, hypertension control.Trial registration numberClinicalTrials.gov, Identifier: NCT02848690. Registered retrospectively on 27 July 2016.

Sodium Restriction in Patients With CKD: A Randomized Controlled Trial of Self-management Support

To evaluate the effectiveness and sustainability of self-managed sodium restriction in patients with chronic kidney disease. Open randomized controlled trial. Patients with moderately decreased kidney function from 4 hospitals in the Netherlands. Regular care was compared with regular care plus an intervention comprising education, motivational interviewing, coaching, and self-monitoring of blood pressure (BP) and sodium. Primary outcomes were sodium excretion and BP after the 3-month intervention and at 6-month follow-up. Secondary outcomes were protein excretion, kidney function, antihypertensive medication, self-efficacy,and health-related quality of life (HRQoL). At baseline, mean sodium excretion rate was 163.6±64.9 (SD) mmol/24 h; mean estimated glomerular filtration rate was 49.7±25.6mL/min/1.73m2; median protein excretion rate was 0.8 (IQR, 0.4-1.7) g/24 h; and mean 24-hour ambulatory systolic and diastolic BPs were 129±15 and 76±9mmHg, respectively. Compared to regular care only (n=71), at 3 months, the intervention group (n=67) showed reduced sodium excretion rate (mean change,-30.3 [95% CI,-54.7 to-5.9] mmol/24 h), daytime ambulatory diastolic BP (mean change,-3.4 [95% CI,-6.3 to-0.6] mmHg), diastolic office BP (mean change,-5.2 [95% CI,-8.4 to-2.1] mmHg), protein excretion (mean change, -0.4 [95% CI, -0.7 to -0.1] g/24h), and improved self-efficacy (mean change, 0.5 [95% CI, 0.1 to 0.9]). At 6 months, differences in sodium excretion rates and ambulatory BPs between the groups were not significant, but differences were detected in systolic and diastolic office BPs (mean changes of-7.3 [95% CI,-12.7 to-1.9] and-3.8 [95% CI,-6.9 to-0.6] mmHg, respectively), protein excretion (mean changes, -0.3 [95% CI, -0.6 to -0.1] g/24h), and self-efficacy (mean change, 0.5 [95% CI, 0.0 to 0.9]). No differences in kidney function, medication, and HRQoL were observed. Nonblinding, relatively low response rate, and missing data. Compared to regular care only, this self-management intervention modestly improved outcomes, although effects on sodium excretion and ambulatory BP diminish over time.

Sodium restriction in patients with cirrhotic ascites: a protocol for a systematic review.

BackgroundAvid renal sodium and water retention among other mechanisms produce ascites in patients with cirrhosis. The main guidelines recommend sodium intake reduction in order to counteract this complication. However, some randomized controlled trials have suggested a lack of benefit with a sodium-restricted over an unrestricted diet, and even an increase in ascites and renal complications has been reported. There are no systematic reviews addressing this question.MethodsA systematic review protocol has been designed and will be reported in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P). We will search for randomized controlled trials evaluating a salt-restricted versus unrestricted regime in patients with cirrhosis and ascites in EMBASE, MEDLINE, and the Cochrane Central Register of Controlled Trials. We will also try to identify literature by reviewing reference list of included studies and relevant reviews, screening main conference proceedings, and searching for unpublished and ongoing trials in the World Health Organization (WHO) International Clinical Trials Registry Platform.Two researchers will independently undertake selection of studies, data extraction, and assessment of the quality of included studies.We will estimate pooled risk ratios for dichotomous data and the mean difference or standardized mean difference for continuous outcomes. A random effect model will be used for meta-analyses. Data synthesis and other analyses will be conducted using RevMan software. Ethics and dissemination: no ethics approval is considered necessary. Results of this study will be disseminated via peer-reviewed publications and social networksDiscussionSodium restriction is a widely accepted coadjuvant therapy for ascites; however, this indication is based primarily on expert recommendations. As far as we know, this will be the first systematic review assessing the effects of a sodium-restricted diet for ascites in cirrhotic patients.Our systematic review will aim to provide a high-quality synthesis of current evidence for patients and clinicians about this question.The main limitation might result from the reduced number and quality of primary studies available.Systematic review registration:PROSPERO CRD42015022161Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-016-0250-4) contains supplementary material, which is available to authorized users.

Salt in the diet in patients with heart failure: what to recommend.

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. 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. 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.

Factors impacting sodium restriction in patients with chronic kidney disease: a cohort study from a Chinese center.

Sodium restriction is important for the management of chronic kidney disease (CKD). The present study evaluated the factors impacting dietary sodium restriction in a cohort of Chinese patients with CKD. A questionnaire on dietary sodium restriction was administered to patients with non-dialysis CKD who visited our CKD clinic from September 2014 to March 2015. Twenty-four-hour urinary sodium excretion (24-h UNa) was measured. Logistic regression was performed to examine the association between patient characteristics and sodium restriction. Two hundred and twenty-nine patients were included in the final analysis. Most of the patients (97.7 %) declared their awareness of the necessity of sodium restriction, but 27.3 % of them chose an incorrect sodium restriction limit. Most of the patients (85.2 %) also reported that they had taken actions to reduce their sodium consumption, with intolerance of sodium restriction as the most common reason for taking no actions. Only 42 patients (18.3 %) had a 24-h UNa of <100 mmol. Multivariable logistic regression showed that age and the use of condiments were independently associated with successful sodium restriction [odds ratio (95 % confidence interval) 1.04 (1.01-1.07), p = 0.006 and 0.38 (0.16-0.88), p = 0.023, respectively]. Most of the patients (83.0 %) did not know how to estimate their sodium intake from condiments. This study indicates that there is much room for improvement in dietary sodium restriction in Chinese patients with CKD. Condiments as a hidden source of sodium intake should be stressed in the education of these patients.

Sodium Restriction in Heart Failure: More Questions and Few Answers

Dietary sodium restriction in heart failure (HF) is a traditional component of HF care, but the sparse data on its impact on outcomes are conflicting. Nevertheless, the concept has physiological face validity, and American College of Cardiology/American Heart Association guidelines support “some degree” of sodium restriction in patients with symptomatic HF, in a class IIa recommendation based on expert consensus. Now, investigators have analyzed observational data on sodium restriction from HART, an NIH-sponsored study. The substudy cohort contained 130 patients …