Prescribed In-Hospital Sodium Intake for ADHF: A Systematic Review and Meta-Analysis
Clinical question: Does prescribed oral and/or IV sodium supplementation plus loop diuretic administration improve outcomes for patients hospitalized with acute decompensated heart failure (ADHF)?
Background: Standard inpatient care for ADHF traditionally involves dietary sodium restriction, but evidence for this approach is mixed. Despite concerns about exacerbating ADHF symptoms, previous studies proposed that supplemental sodium in combination with loop diuretics could improve diuretic efficacy, particularly in patients with diuretic resistance and worsening cardiorenal syndrome.
Study design: Systematic review and meta-analysis that synthesized evidence from randomized controlled trials and nonrandomized comparative studies. The 16 studies included were conducted across various regions worldwide.
Synopsis: The review found that supplemental sodium (mostly IV hypertonic saline) with furosemide significantly decreased serum creatinine (pooled net mean difference [NMD]: -0.33 mg/dL) and brain natriuretic peptide (BNP) (pooled NMD: -62.84 pg/mL). It also led to a significant decrease in weight (pooled NMD: -2.48 kg) and a shorter length of hospital stay (pooled NMD: -2.68 days). There were no significant differences in N-terminal pro–B-type natriuretic peptide (NT-proBNP). Studies provided insufficient evidence on mortality and readmission outcomes, and no evidence for caloric intake or clinical congestion scores. No reports of worsening pulmonary edema or hypoxia were noted with sodium supplementation.
Bottom line: Sodium supplementation with loop diuretics for patients hospitalized with ADHF may improve kidney function, promote weight loss, and shorten hospital stay. This meta-analysis did not show serious renal outcomes or worsening congestive symptoms; however, further research is needed to confirm effectiveness and optimize strategies, as well as investigate mortality and readmission outcomes.
Citation: Maih HJ, et al. Prescribed in-hospital sodium intake for decompensated heart failure: a systematic review and meta-analysis. J Hosp Med. 2025;1-9. doi:10.1002/jhm.70091.
Dr. Brooks is a hospitalist in the South Texas Veterans Health Care System and an adjoint associate professor in the division of internal medicine at UT Health San Antonio in San Antonio.