Author + information
- Fu Biao and
- Lan Huang
International guidelines have recommended fluid restriction for patients with chronic heart failure (CHF). However, this recommendation lacks scientific evidence. This study sought to evaluate effect of fluid restriction on patients with heart failure in randomized controlled trials.
Randomized controlled trials were identified in MEDLINE, EMBASE, and Cochran data base by using the search-keyword of fluid and heart failure. The liberal fluid intake and restricted fluid therapy was compared in heart failure patients. The risk ratio (RR) and mean difference (MD) were calculated from abstracted data. The studies focused on decompensated heart failure were separated from compensated heart failure as a sensitivity analysis.
6 randomized trials were included. Between liberal and restricted fluid groups, there was no difference in readmission (RR=1.32; 95% CI: 0.86 to 2.01; p=0.2), mortality (RR=1.50; 95% CI: 0.87 to 2.57; p=0.14), perceived thirst (MD=-0.7; 95% CI: -2.58 to 1.17; p=0.46), duration of intravenous diuretics (MD=0.17; 95% CI: -1.26 to 1.6; p=0.81) and serum sodium (MD=-1.61; 95% CI: -3.28 to 0.07; p=0.06). With significant heterogeneity in those trials, the pooled MD of creatinine and BNP in the liberal versus restricted fluid group was 0.20 (95% CI: 0.15 to 0.25; p<0.00001) and 172.59 (95% CI: 67.38 to 277.8; p=0.001) respectively. All endpoints showed no difference between liberal and restricted fluid groups without heterogeneity after removing the study that recruited patients with severe impairment of left ventricular ejection fraction (LVEF).
Compared with liberal fluid intake, restrictive fluid prescription did not show more benefit for patients with heart failure, especially for those without severe impairment of LVEF. However, the total sample size for each outcome measured was too small to detect true differences between groups.