Guidelines

Challenging the Salt Restriction Norm

It is common practice to restrict dietary salt to alleviate or prevent “volume overload” in patients with acute decompensated heart failure (ADHF). But a new study reveals that this standard may be unnecessary. 

This double-blind randomized controlled trial investigated whether taking salt pills may actually benefit patients with ADHF undergoing intensive diuresis. Turns out, the approach made no difference to weight loss on diuresis (a proxy for volume reduction) or serum creatine levels in ADHF patients receiving high-dose IV diuretic therapy. 

The Cleveland Clinic researchers instructed 65 patients hospitalized with ADHF to take either placebo or 6mg salt per day (approximately equivalent to six servings of fast-food french fries) during diuresis for up to 96 hours. The primary endpoint was change in creatinine and weight at 96 hours.

  • The authors found that change in weight (–4 vs. –4.6 kg) and creatine (0.04 vs. 0.15 mg/dL) was comparable between the salt-ingesters and the placebo group. 
  • The authors also noted a smaller decrease in serum sodium (–0.03 vs. –2.6) and a smaller mean increase in blood urea nitrogen (3.1 vs. 11 mEq/L) in salt-ingesters versus the placebo group.
  • The trial was not powered to detect differences in serious adverse events, but the researchers reported that they observed none.

The Takeaway

These results challenge the routine practice of restricting salt consumption in ADHF cases. Nothing catastrophic happened when patients ingested salt in bulk; weight and creatine levels were similar between the experimental and control groups. 

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-- The Cardiac Wire Team