TY - JOUR
T1 - Liberal fluid intake versus fluid restriction in chronic heart failure
T2 - a randomized clinical trial
AU - Herrmann, Job J.
AU - Brunner-La Rocca, Hans Peter
AU - Baltussen, Lisette E.H.J.M.
AU - Beckers-Wesche, Fabienne
AU - Bekkers, Sebastiaan C.A.M.
AU - Bellersen, Louise
AU - van Eck, J. W.Martijn
AU - Hassing, H. Carlijne
AU - Jaarsma, Tiny
AU - Linssen, Gerard C.M.
AU - Pisters, Ron
AU - Sanders-van Wijk, Sandra
AU - Verdijk, Marjolein H.I.
AU - Handoko, M. Louis
AU - van der Meer, Peter
AU - Verbrugge, Frederik H.
AU - Januzzi, James L.
AU - Bayés-Genís, Antoni
AU - Nieuwlaat, Robby
AU - Rodwell, Laura
AU - Gommans, D. H.Frank
AU - van Kimmenade, Roland R.J.
N1 - Publisher Copyright:
© The Author(s), under exclusive licence to Springer Nature America, Inc. 2025.
PY - 2025/6
Y1 - 2025/6
N2 - Fluid restriction is frequently recommended to patients with chronic heart failure, but randomized clinical trials assessing the effects of fluid restriction remain scarce. In this multicenter open-label trial, outpatients with chronic heart failure were randomized to receiving advice for liberal fluid intake versus receiving advice for fluid restriction, up to 1,500 ml per day of fluid intake. The primary outcome of the trial was health status after 3 months, as assessed by the Kansas City Cardiomyopathy Questionnaire Overall Summary Score (KCCQ-OSS). Secondary outcomes included thirst distress and safety events. Among 504 randomized patients (67.3% male), the KCCQ-OSS after 3 months was 74.0 in the liberal fluid intake group versus 72.2 in the fluid restriction group, with a mean difference after adjustment for baseline scores of 2.17 (95% confidence interval −0.06 to 4.39; P = 0.06), indicating that the primary outcome was not met. Thirst distress was higher in the fluid restriction group and no differences were observed for safety events between the two groups. These findings question the benefit of fluid restriction in chronic heart failure. ClinicalTrials.gov registration: NCT04551729.
AB - Fluid restriction is frequently recommended to patients with chronic heart failure, but randomized clinical trials assessing the effects of fluid restriction remain scarce. In this multicenter open-label trial, outpatients with chronic heart failure were randomized to receiving advice for liberal fluid intake versus receiving advice for fluid restriction, up to 1,500 ml per day of fluid intake. The primary outcome of the trial was health status after 3 months, as assessed by the Kansas City Cardiomyopathy Questionnaire Overall Summary Score (KCCQ-OSS). Secondary outcomes included thirst distress and safety events. Among 504 randomized patients (67.3% male), the KCCQ-OSS after 3 months was 74.0 in the liberal fluid intake group versus 72.2 in the fluid restriction group, with a mean difference after adjustment for baseline scores of 2.17 (95% confidence interval −0.06 to 4.39; P = 0.06), indicating that the primary outcome was not met. Thirst distress was higher in the fluid restriction group and no differences were observed for safety events between the two groups. These findings question the benefit of fluid restriction in chronic heart failure. ClinicalTrials.gov registration: NCT04551729.
UR - https://www.scopus.com/pages/publications/105001484001
U2 - 10.1038/s41591-025-03628-4
DO - 10.1038/s41591-025-03628-4
M3 - Article
C2 - 40159556
AN - SCOPUS:105001484001
SN - 1078-8956
VL - 31
SP - 2062
EP - 2068
JO - Nature Medicine
JF - Nature Medicine
IS - 6
ER -