Dietary Sodium and Fluid Intake in Heart Failure. A Clinical Consensus Statement of the Heart Failure Association of the ESC
Wilfried Müllens, Kevin Damman, Sebastiaan Dhont, Debasish Banerjee, Antoni Bayés‐Genís, Antonio Cannatà, Ovidiu Chioncel, Maja Čikeš, Justin A. Ezekowitz, Andreas J. Flammer, Pieter Martens, Alexandre Mebazaa, Robert J. Mentz, Òscar Miró, Brenda Moura, Julio Núñez, Jozine M. ter Maaten, Jeffrey M. Testani, Roland van Kimmenade, Frederik H. Verbrugge, Marco Metra, Giuseppe Rosano, Gerasimos Filippatos
Abstract
Sodium and fluid restriction has traditionally been advocated in patients with heart failure (HF) due to their sodium and water avid state. However, most evidence regarding the altered sodium handling, fluid homeostasis and congestion-related signs and symptoms in patients with HF originates from untreated patient cohorts and physiological investigations. Recent data challenge the beneficial role of dietary sodium and fluid restriction in HF. Consequently, the European Society of Cardiology HF guidelines have gradually downgraded these recommendations over time, now advising for the limitation of salt intake to no more than 5 g/day in patients with HF, while contemplating fluid restriction of 1.5-2 L/day only in selected patients. Therefore, the objective of this clinical consensus statement is to provide advice on fluid and sodium intake in patients with acute and chronic HF, based on contemporary evidence and expert opinion.