Fluid intake impact on heart failure: Systematic review and meta-analysis with trial sequential analysis
Background: Heart failure (HF) management lacks clarity regarding fluid balance strategies, with some studies suggesting potential benefits of liberal fluid intake. This review aims to evaluate both unrestricted and restricted fluid intake, including sodium restriction, in adult HF. Methods: A thoro...
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| Format: | Article |
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Elsevier
2025-07-01
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| Series: | Journal of the Formosan Medical Association |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S0929664624005540 |
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| author | Suh-Meei Hsu Yueh-Hung Lin Ying-Chun Lin Shu-Jung Liu Chih-Ju Liu Chung-Lieh Hung Tsae-Jyy Wang |
| author_facet | Suh-Meei Hsu Yueh-Hung Lin Ying-Chun Lin Shu-Jung Liu Chih-Ju Liu Chung-Lieh Hung Tsae-Jyy Wang |
| author_sort | Suh-Meei Hsu |
| collection | DOAJ |
| description | Background: Heart failure (HF) management lacks clarity regarding fluid balance strategies, with some studies suggesting potential benefits of liberal fluid intake. This review aims to evaluate both unrestricted and restricted fluid intake, including sodium restriction, in adult HF. Methods: A thorough search of electronic databases, including PubMed, MEDLINE, and Cochrane Library, identified relevant studies examining fluid intake effects on adult heart failure patients, categorized by liberal or restricted intake, with subgroup analysis on sodium restriction. Pooled odds ratios (OR) and weighted mean differences (WMD) were calculated, employing trial sequential analysis (TSA) for reliability. Nine studies involving 961 patients were included, with follow-up durations ranging from 2 days to 6 months. Results: Daily fluid intake ranged from 0.8 to 1.5 L for the intervention group, and sodium intake varied from 2.0 to 5.0 g per day across five studies. No significant differences were observed in re-hospitalization rate, mortality rate, thirst, quality of life, doses of diuretics, or serum sodium levels between liberal and restricted intake groups. However, fluid-restricted patients exhibited increased serum creatinine levels, decreased serum B-type natriuretic peptide (BNP) levels and reduced body weight. Conclusion: In summary, the existing studies on this topic are hindered by heterogeneity and relatively small sample sizes. However, when the available data is combined, it suggests that HF patients managed with either liberal or restrictive fluid intake exhibit similar clinical outcomes. It's worth noting that fluid restriction in HF patients might lead to increased serum creatinine levels, decreased BNP and body weight. |
| format | Article |
| id | doaj-art-5acfcbfb76dd48ceadc1c1eed79432f2 |
| institution | Kabale University |
| issn | 0929-6646 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of the Formosan Medical Association |
| spelling | doaj-art-5acfcbfb76dd48ceadc1c1eed79432f22025-08-20T03:24:07ZengElsevierJournal of the Formosan Medical Association0929-66462025-07-01124765065910.1016/j.jfma.2024.11.017Fluid intake impact on heart failure: Systematic review and meta-analysis with trial sequential analysisSuh-Meei Hsu0Yueh-Hung Lin1Ying-Chun Lin2Shu-Jung Liu3Chih-Ju Liu4Chung-Lieh Hung5Tsae-Jyy Wang6Nursing and Management, MacKay Junior College of Medicine, Taipei, Taiwan; Department of Nursing, MacKay Memorial Hospital, Taipei, 10449, Taiwan; Institute of Nursing, College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, TaiwanDepartment of Medicine, MacKay Medical College, New Taipei City, 25245, Taiwan; Division of Cardiology, Departments of Internal Medicine, MacKay Memorial Hospital, Taipei, 10449, Taiwan; Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, TaiwanNursing and Management, MacKay Junior College of Medicine, Taipei, Taiwan; Division of Anesthesiology, MacKay Memorial Hospital, Taipei, 10449, Taiwan; Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, TaiwanDepartment of Medical Library, MacKay Memorial Hospital, Tamsui Branch, New Taipei City, TaiwanNursing and Management, MacKay Junior College of Medicine, Taipei, Taiwan; Department of Nursing, MacKay Memorial Hospital, Taipei, 10449, TaiwanDepartment of Medicine, MacKay Medical College, New Taipei City, 25245, Taiwan; Division of Cardiology, Departments of Internal Medicine, MacKay Memorial Hospital, Taipei, 10449, Taiwan; Corresponding author. Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Road, Taipei, Taiwan.Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Corresponding author. Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Road, Taipei, TaiwanBackground: Heart failure (HF) management lacks clarity regarding fluid balance strategies, with some studies suggesting potential benefits of liberal fluid intake. This review aims to evaluate both unrestricted and restricted fluid intake, including sodium restriction, in adult HF. Methods: A thorough search of electronic databases, including PubMed, MEDLINE, and Cochrane Library, identified relevant studies examining fluid intake effects on adult heart failure patients, categorized by liberal or restricted intake, with subgroup analysis on sodium restriction. Pooled odds ratios (OR) and weighted mean differences (WMD) were calculated, employing trial sequential analysis (TSA) for reliability. Nine studies involving 961 patients were included, with follow-up durations ranging from 2 days to 6 months. Results: Daily fluid intake ranged from 0.8 to 1.5 L for the intervention group, and sodium intake varied from 2.0 to 5.0 g per day across five studies. No significant differences were observed in re-hospitalization rate, mortality rate, thirst, quality of life, doses of diuretics, or serum sodium levels between liberal and restricted intake groups. However, fluid-restricted patients exhibited increased serum creatinine levels, decreased serum B-type natriuretic peptide (BNP) levels and reduced body weight. Conclusion: In summary, the existing studies on this topic are hindered by heterogeneity and relatively small sample sizes. However, when the available data is combined, it suggests that HF patients managed with either liberal or restrictive fluid intake exhibit similar clinical outcomes. It's worth noting that fluid restriction in HF patients might lead to increased serum creatinine levels, decreased BNP and body weight.http://www.sciencedirect.com/science/article/pii/S0929664624005540Heart failureFluid intakeClinical outcomesre-hospitalizationSodium levelsSerum creatinine |
| spellingShingle | Suh-Meei Hsu Yueh-Hung Lin Ying-Chun Lin Shu-Jung Liu Chih-Ju Liu Chung-Lieh Hung Tsae-Jyy Wang Fluid intake impact on heart failure: Systematic review and meta-analysis with trial sequential analysis Journal of the Formosan Medical Association Heart failure Fluid intake Clinical outcomes re-hospitalization Sodium levels Serum creatinine |
| title | Fluid intake impact on heart failure: Systematic review and meta-analysis with trial sequential analysis |
| title_full | Fluid intake impact on heart failure: Systematic review and meta-analysis with trial sequential analysis |
| title_fullStr | Fluid intake impact on heart failure: Systematic review and meta-analysis with trial sequential analysis |
| title_full_unstemmed | Fluid intake impact on heart failure: Systematic review and meta-analysis with trial sequential analysis |
| title_short | Fluid intake impact on heart failure: Systematic review and meta-analysis with trial sequential analysis |
| title_sort | fluid intake impact on heart failure systematic review and meta analysis with trial sequential analysis |
| topic | Heart failure Fluid intake Clinical outcomes re-hospitalization Sodium levels Serum creatinine |
| url | http://www.sciencedirect.com/science/article/pii/S0929664624005540 |
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