Evidence related to sodium restriction in patients with heart failure

ABSTRACT Objectives: to analyze the scientific production about sodium restriction in patients with heart failure. Methods: integrative literature review from articles published from 2007 to 2017, located in the CINAHL and Scopus databases. Results: thirteen studies were analyzed. Sodium intake restriction was associated with lower unfavorable clinical outcomes in patients with marked symptomatology. The 24-hour urine sodium dosage was the main tool to assess adherence to the low sodium diet. Conclusions: based on the studies included in this review, in symptomatic patients, dietary sodium restriction should be encouraged in clinical practice as a protective measure for health. However, in asymptomatic patients, it should be well studied.

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Adrenergic control of renin during dietary sodium deprivation in conscious dogs

AJP Endocrinology and Metabolism ◽

10.1152/ajpendo.1989.256.6.e863 ◽

1989 ◽

Vol 256 (6) ◽

pp. E863-E871 ◽

Cited By ~ 1

Author(s):

H. Hisa ◽

Y. H. Chen ◽

K. J. Radke ◽

J. L. Izzo ◽

C. D. Sladek ◽

...

Keyword(s):

Sodium Intake ◽

Conscious Dogs ◽

Dietary Sodium ◽

Sodium Restriction ◽

Adrenergic Stimulation ◽

Sodium Diet ◽

Low Sodium Diet ◽

Low Sodium ◽

Dietary Sodium Restriction

These experiments evaluated the contribution of alpha- and beta-adrenergic stimulation to plasma renin activity (PRA) during early and long-term dietary sodium restriction, compared with normal sodium intake. Uninephrectomized conscious dogs with catheters in the aorta, vena cava, and remaining renal artery were studied during normal sodium diet (approximately 70 meq/day), after 2-3 days of low-sodium diet (5-7 meq/day), and after greater than or equal to 2 wk of low-sodium diet. Direct renal arterial (ira) infusion of phenoxybenzamine plus propranolol decreased PRA by similar proportions (39-48%) during all three states of dietary sodium intake. The PRA achieved after adrenergic blockade remained higher (P less than 0.05) during early and long-term sodium restriction than during normal sodium intake. The effect on PRA of ira infusion of propranolol alone was not different from that of phenoxybenzamine plus propranolol during normal or low-sodium diet, and the magnitude of decrease in PRA during low-sodium diet was the same whether propranolol (1 microgram.kg-1.min-1) was infused ira or intravenously. In summary, beta-adrenergic stimulation accounts for similar proportions of PRA during early and long-term dietary sodium restriction and during normal sodium intake. Renal alpha-adrenoceptors appear to play little or no role in control of PRA under these conditions.

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Achieving Salt Restriction in Chronic Kidney Disease

International Journal of Nephrology ◽

10.1155/2012/720429 ◽

2012 ◽

Vol 2012 ◽

pp. 1-10 ◽

Cited By ~ 34

Author(s):

Emma J. McMahon ◽

Katrina L. Campbell ◽

David W. Mudge ◽

Judith D. Bauer

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Sodium Intake ◽

Epidemiological Studies ◽

Dietary Sodium ◽

Sodium Restriction ◽

Restricted Diet ◽

Salt Restriction ◽

Low Sodium Diet ◽

Low Sodium

There is consistent evidence linking excessive dietary sodium intake to risk factors for cardiovascular disease and chronic kidney disease (CKD) progression in CKD patients; however, additional research is needed. In research trials and clinical practice, implementing and monitoring sodium intake present significant challenges. Epidemiological studies have shown that sodium intake remains high, and intervention studies have reported varied success with participant adherence to a sodium-restricted diet. Examining barriers to sodium restriction, as well as factors that predict adherence to a low sodium diet, can aid researchers and clinicians in implementing a sodium-restricted diet. In this paper, we critically review methods for measuring sodium intake with a specific focus on CKD patients, appraise dietary adherence, and factors that have optimized sodium restriction in key research trials and discuss barriers to sodium restriction and factors that must be considered when recommending a sodium-restricted diet.

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Long-Term Adherence to Low-Sodium Diet in Patients With Heart Failure

Western Journal of Nursing Research ◽

10.1177/0193945916681003 ◽

2017 ◽

Vol 39 (4) ◽

pp. 553-567 ◽

Cited By ~ 4

Author(s):

Misook L. Chung ◽

Linda Park ◽

Susan K. Frazier ◽

Terry A. Lennie

Keyword(s):

Heart Failure ◽

Patient Adherence ◽

Sodium Intake ◽

Dietary Sodium ◽

Factors Affecting ◽

Sodium Diet ◽

Low Sodium Diet ◽

Low Sodium ◽

Positive Attitudes

Although following a low-sodium diet (LSD) for heart failure (HF) has been recommended for decades, little is known about factors related to long-term patient adherence. The purposes of this study were to (a) compare sodium intake and factors affecting adherence in a long-term adherent group and in a non-adherent group and (b) examine predictors of membership in the long-term adherent group. Patients with HF ( N = 74) collected 24-hr urine samples and completed the Dietary Sodium Restriction Questionnaire and the Patient Health Questionnaire-9. Long-term adherence was determined using the Stage of Dietary Behavior Change Scale. The long-term adherent group had lower sodium intake (3,086 mg vs. 4,135 mg, p = .01) and perceived more benefits from LSD than the non-adherent group. Only positive attitudes toward LSD predicted membership in the long-term adherence group (odds ratio [OR] = 1.18, p = .005). Interventions focused on enhancing positive perceptions of the benefits of an LSD may improve long-term dietary adherence in patients with HF.

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A LITERATURE REVIEW: LOW SODIUM RESTRICTION OF PATIENTS WITH HEART FAILURE ON HOSPITAL READMISSION

Nursing Current Jurnal Keperawatan ◽

10.19166/nc.v9i2.4917 ◽

2021 ◽

Vol 9 (2) ◽

pp. 128

Author(s):

Septa Meriana Lumbantoruan

Keyword(s):

Heart Failure ◽

Literature Review ◽

Sudden Death ◽

Beneficial Effect ◽

Hospital Readmission ◽

Sodium Intake ◽

Experimental Studies ◽

Sodium Restriction ◽

Low Sodium ◽

Patients With Heart Failure

<p>Sodium restriction effect on hospital readmission in patients with heart failure (HF) has been questioned for decades. Readmission related to low sodium intake recommendations should be changed as well as mortality. A literature review is needed to summarize the effect of low sodium, especially on readmission and mortality. This literature review aimed to summarize the prevalence of hospital readmission and mortality regarding low sodium intake in patients with HF. The searching process involved four databases; MEDLINE, Embase, EBSCO Health, Cochrane was explored for experimental studies of sodium restriction. Of 77 screened citations from 2000 to 2019 invested in patients with HF, four studies were included. Four studies from four databases were included and explained and it was found that hospital readmission was the outcome of implementing sodium restriction in patients with HF. Low sodium restriction (800 mg – 1800 mg/day) results in higher hospital readmission. Moreover, 1800 mg/day of sodium was followed by higher mortality and higher sudden death in patients with HF. Low sodium restriction did not lower hospital readmission as well as mortality of patients with HF. This article provides the reason, effect, and amount of sodium restriction in patients with HF. The recommendation from this literature review is low sodium restriction has no beneficial effect on readmission and mortality in HF conditions.</p>

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Interventions for Dietary Sodium Restriction Among Patients with Heart Failure: A Mismatch in the Evidence and Intervention Design (OR22-05-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz028.or22-05-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Marissa Burgermaster ◽

Rebecca Rudel ◽

David Seres

Keyword(s):

Heart Failure ◽

Social Support ◽

Perceived Risk ◽

Sodium Intake ◽

Dietary Sodium ◽

Secondary Outcome ◽

Evidence Based ◽

Sodium Restriction ◽

Patients With Heart Failure ◽

Dietary Sodium Restriction

Abstract Objectives Dietary sodium restriction guidelines are controversial due to a lack of studies assessing their effect on heart failure outcomes. An important aspect of this problem is the effectiveness of behavioral nutrition interventions to reduce patients’ sodium intake. We systematically reviewed randomized controlled trials (RCTs) of sodium restricted diets and descriptive studies relating mediators of behavior to successful adherence to sodium restricted diets in patients with heart failure. Methods We queried PubMed, CINAHL, and Cochrane databases with relevant search terms for studies published in English January 2000-December 2018. Included were RCTs of interventions for heart failure patients, with sodium restriction as a primary or secondary outcome, and quantitative and qualitative descriptive studies of adherence to sodium restricted diets. Included studies may or may not have reported clinical outcomes (health events, quality of life, etc.). Reviewers noted setting, methods, and outcomes as well as theoretical mediators of dietary behavior change in included studies. We then compared behavioral mediators addressed by the RCTs and behavioral mediators identified in the descriptive studies. Results Of 638 studies identified, 445 were excluded by title. 2 reviewers assessed 60 abstracts and included 36 studies in this analysis: 10 RCTs and 26 descriptive studies. 6 of 10 intervention RCTs were successful, but no interventions achieved the recommended 1500 mg/day sodium intake (mean for all studies 3271 mg/day). Interventions that reduced sodium intake were behaviorally focused, were delivered by an RN and/or RD, and included individual feedback and counseling. RCTs intervened only through knowledge, skills, and social support. Behavioral mediators identified in descriptive studies included perceived risk, perceived benefits, outcome expectations, cultural norms, social norms, social support, taste preferences, determinism, self-efficacy, knowledge, skills, and habits. These were not included in the RCTs, which signifies a mismatch between evidence-based moderators of behavior and intervention designs. Conclusions RCTs have been unable to achieve the recommended goal of 1500 mg/day of sodium. More effective interventions should consider evidence-based mediators, rather than focusing on knowledge and skills. Funding Sources Dr. Burgermaster received funding from NHLBI T32 training grant.

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Abstract 17541: An Education Intervention Focused on Self-monitoring for Symptom and Sodium Intake Improves Adherence to the Low Sodium Diet and Health Outcome in Patients with Heart Failure

Circulation ◽

10.1161/circ.130.suppl_2.17541 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Eun Kyeung Song ◽

Debra K Moser ◽

Seok-Min Kang ◽

Terry A Lennie

Keyword(s):

Health Outcomes ◽

Cox Regression ◽

Sodium Intake ◽

Control Group ◽

Education Intervention ◽

Self Monitoring ◽

Sodium Diet ◽

Low Sodium Diet ◽

Low Sodium ◽

Patients With Heart Failure

Background: Despite the clinical emphasis on recommending a low sodium diet (LSD), adherence to a LSD remains poor in patients with heart failure (HF). Additional research is needed to determine successful interventions to improve adherence to a LSD and health outcomes. Purpose: To determine the effect of an education intervention on adherence to a LSD and health outcomes. Method: A total of 109 HF patients (age 64±9 years, 29% female) who were non-adherent to LSD, indicating > 3g of 24-hour urinary sodium excretion (24hr UNa) at baseline, were randomly assigned to one of 3 groups: 1) symptom monitoring and restricted 3 gram sodium diet (SMART) group, 2) the telephone monitoring (TM) group, or 3) usual care control group. The SMART group received individualized teaching and guidance of self-monitoring for worsening symptom and sodium intake using symptom and food diary for 4 sessions over 8 weeks. Patients assigned to either of the 2 intervention groups (SMART or TM) received phone calls every 2 weeks over 8 weeks. At 6 months follow-up, adherence to a LSD was assessed using 24hr UNa. Patients were followed for 1 year to determine time to first event of hospitalization or death due to cardiac problems. Repeated measures ANOVA and Cox regression were used to determine the effect of intervention. Results: The SMART group (n=37) showed a significant reduction in sodium intake across time compared to the TM group (n=35) and control group (n=37) (p= .022). In the Cox regression, patients in the SMART group had longer cardiac event-free survival compared to the control group after controlling for age, gender, ejection fraction, angiotensin-converting enzyme inhibitor use, and better blocker use (p=.008). Conclusion: An education intervention focused on self-monitoring for symptom and sodium intake improved adherence to LSD and health outcomes in patients with HF. Helping patients engage in self-monitoring for symptom and sodium intake by themselves can promote better health outcome.

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The effectiveness of reducing dietary sodium intake versus normal dietary sodium intake in patients with heart failure on reducing readmission rate: a systematic review protocol

The JBI Database of Systematic Reviews and Implementation Reports ◽

10.11124/jbisrir-2014-1095 ◽

2014 ◽

Vol 12 (2) ◽

pp. 125-131

Author(s):

Palle Larsen ◽

Preben U Pedersen ◽

Amalia Tsiamil

Keyword(s):

Heart Failure ◽

Systematic Review ◽

Readmission Rate ◽

Sodium Intake ◽

Dietary Sodium ◽

Systematic Review Protocol ◽

Patients With Heart Failure ◽

Review Protocol

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Development of two-kidney Goldblatt hypertension in rats under dietary sodium restriction

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.1980.238.6.h889 ◽

1980 ◽

Vol 238 (6) ◽

pp. H889-H894 ◽

Cited By ~ 3

Author(s):

H. Munoz-Ramirez ◽

R. E. Chatelain ◽

F. M. Bumpus ◽

P. A. Khairallah

Keyword(s):

Blood Pressure ◽

Plasma Renin Activity ◽

Plasma Renin ◽

Renin Activity ◽

Dietary Sodium ◽

Sodium Restriction ◽

Sodium Diet ◽

Low Sodium Diet ◽

Low Sodium ◽

Goldblatt Hypertension

In Sprague-Dawley rats with unilateral renal artery stenosis and an intact contralateral kidney, administration of a low-sodium diet did not prevent the development of hypertension. Despite an elevated blood pressure, hyponatremia, marked activation of the renin-angiotensin system, and increased hematocrit values, only 10% of the rats showed lesions of malignant hypertension. Systolic blood pressures of one- and two-kidney sham-operated rats fed a low-sodium diet were significantly higher than that of normotensive controls fed a normal diet. Uninephrectomy did not reduce plasma renin activity. The low-sodium diet increased plasma renin activity to about the same level in one- and two-kidney normotensive rats. However, the increase in plasma renin activity elicited by dietary sodium restriction was markedly less in one-kidney Goldblatt hypertension. Systolic blood pressure reached similar levels in one- and two-kidney Goldblatt hypertensive rats fed a low-sodium diet. These data indicate that a decrease in sodium intake does not prevent the development of two-kidney Goldblatt hypertension.

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