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Título

DIETARY SODIUM RESTRICTION OF LESS THAN 2500 MG/DAY IN HEART FAILURE PATIENTS: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

Resumo

BACKGROUND: Limiting sodium intake is a common self-care recommendation for patients with heart failure. Previous meta-analyses have explored different degrees of sodium restriction. However, consensus on the specific recommended sodium level is lacking. OBJECTIVE: We aimed to evaluate the effects of sodium restriction of less than 2500mg/day on cardiovascular and clinical outcomes in heart failure patients. METHODS: This meta-analysis followed the PRISMA approach (PROSPERO: CRD42024530668). PubMed, Embase, and Cochrane databases were searched for randomized controlled trials comparing sodium restriction (<2500mg/day) to a standard sodium diet for heart failure patients. Endpoints were systolic blood pressure (SBP), body weight (BW), Kansas City Cardiomyopathy Questionnaire (KCCQ) score, all-cause death, and cardiovascular hospitalization. Studies employing co-interventions with high doses of diuretics were excluded. A random-effects model was applied using R software. Binary and continuous outcomes were indicated as relative risk and mean difference, respectively. Heterogeneity was assessed using I² statistics. The Confidence Interval (CI) was set at 95%. RESULTS: Ten studies enrolling 1268 patients were included, with a mean age of 64.7±5.07 years and a sample of 630 in the intervention arm. Sodium restriction showed a more significant decrease in baseline BW compared to the standard sodium arm (mean difference -0.32; 95%CI [-0.56;-0.07]; p=0.011; I²=0%). The results for BW were similar when a subgroup of patients with Left Ventricular Ejection Fraction (LVEF) ≤45% was analyzed (mean difference -0.33; 95%CI [-0.58;-0.08]; p=0.009; I²=0%). Sodium restriction had a significant effect on reducing SBP at the end of the follow-up period (mean difference -6.81; 95%CI [-8.59;-5.04]; p<0.001; I²=0%). The KCCQ clinical summary score was higher in the restriction arm, indicating fewer symptoms and physical limitations (mean difference 8.25; 95%CI [0.80;15.70]; p=0.03; I²=67%). However, limiting sodium showed no statistical significance on reducing the risk of all-cause death and cardiovascular-related hospitalization. The results were similar in subgroup analysis for LVEF≤45%. CONCLUSION: Sodium restriction of less than 2500mg/day in heart failure patients was significantly linked to greater weight loss, lower SBP, and improvement in KCCQ score. However, it was not associated with reduced mortality or hospitalizations.

Palavras Chave

Heart Failure; Sodium-Restricted

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