Clinical InvestigationLong-Term Effects of Dietary Sodium Intake on Cytokines and Neurohormonal Activation in Patients With Recently Compensated Congestive Heart Failure
Section snippets
Patient Population
Between September 2005 and August 2007, 192 patients were consecutively admitted to Biomedical Department of Internal and Specialist Medicine of the University Hospital of Palermo and to department of Cardiology of G.F. Ingrassia Hospital (Palermo) with worsening HF.
Inclusion Criteria
We included into the study only compensated patients who previously were hospitalized (previous 30 days) for recently decompensated congestive HF with the following characteristics: patients had to have, according to the definition
Results
Of the 192 acute HF patients discharged in compensate state and dry profile, 9 patients refused consent to participate to study after discharge, and 10 patients during the 30-day period after discharge did not follow the prescribed limited drink fluid intake (1000 mL) and were also excluded from the study. We obtained 173 (female/male: 68/105) (mean age 72.5 ± 7 years) compensated congestive HF patients (NYHA Class II) and dry weight of different etiologies (84 coronary artery disease, 57
Discussion
To our knowledge, this is the first investigation to assess the effects of 2 different sodium diets in medically treated patients with compensated HF and dry weight on neurohormonal and cytokines activation during 12 months of follow-up. We choose 120 mmol to 2.8 g of Na because epidemiological studies showed that in Europe and Italy it was estimated an assumption of a mean of 3.5 g (150 mmol) Na/day.19, 20 Our data suggest that a moderate sodium restriction with a limited drink fluid intake (1 L)
Conclusion
To date, this counterintuitive approach underlines the need for better understanding of factors that regulate Na and water handling in chronic congestive HF. The observation that the combination of high dose of loop diuretics with moderate sodium restriction may improve clinical outcome and do not determine detrimental effects in renal function suggests that Na depletion has detrimental renal and neurohormonal effects with worse clinical outcome in patients with compensated congestive HF.6, 8,
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2022, Clinical Nutrition ESPENCitation Excerpt :Almost all patients were on optimal pharmacological therapy, including angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs), beta-blockers, spironolactone, digitalis, and loop diuretics. Regarding interventions and follow-up, three studies compared fluid restriction versus usual care [9,20,21], with follow-up ranging from 2 to 6 months. The characteristics of fluid restriction included absolute values, such as 1 L/day [9,20], and weight-standardized doses, such as 30 mL/kg/day [21].
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The authors have no conflicts of interest.