Sodium

HESI: Congestive Heart Failure Population (2014)

• Assessment
  What are the associations between renin or aldosterone levels and health outcomes in CHF patients?

  • Conclusion
    Limited evidence indicates that aldosterone levels, plasma renin activity and hospital re-admissions decrease in compensated CHF patients on a dietary sodium intake of approximately 2,760mg per day (120mmol per day), relative to a sodium intake of 1,840mg per day (80mmol per day). The risk of mortality, however, while lower in the higher intake group, did not differ significantly between sodium intake groups.
  • Grade: I
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What are the associations between renin or aldosterone levels and health outcomes in CHF patients?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Paterna S, Gaspare P, Fasullo S, Sarullo FM, Di Pasquale P. Normal-sodium diet compared with low-sodium diet in compensated congestive heart failure: Is sodium and old enemy or a new friend? Clinical Science. 2008; 114: 221-230.  
      • Paterna S, Parrinello G, Cannizzaro S, Fasullo S, Torress D, Sarullo F, DiPasquale P. Medium term effects of different dosage of diuretic, sodium, and fluid administration on neurohormonal and clinical outcome in patients with recently compensated heart faliure. Am J Cardiol. 2009; 103: 93-102.
  • Search Plan and Results: Sodium and CHF
     
• Intervention
  What is the effect of dietary sodium intake on renal function in patients with congestive heart failure?

  • Conclusion

    There is limited evidence that significant reductions in sodium intake in someone with CHF may decrease glomerular filtration rate. From the studies analyzed, it is not known whether the change is either harmful or irreversible.

  • Grade: II
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What is the effect of dietary sodium intake on renal function in patients with congestive heart failure?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Alvelos M, Ferreira A, Bettencourt P et al. The effect of dietary sodium restriction on neurohumoral activity and renal dopaminergic response in patients with heart failure. Eur J Heart Failure. 2004; 6: 593-599.
      •  Parrinello G, Pasquale PD, Licata G, Tirres DM Giammanco DM, Fasullo S, Mezzero M, Paterna S. Long-term effects of dietary sodium intake on cytokines and neurohormonal activation in patients with recently compensated congestive heart failure. J Card Fail. 2009; 15(10): 864-873. 
      • Riegger GAJ, Kahles HW, Elsner D, Kromer EP, Kochsiek K. Effects of acetylsalicylic acid on renal function in patients with chronic heart failure. Am J Med. 1991, 90: 571-575.
  • Search Plan and Results: Sodium and CHF
     
  What is the effect of dietary sodium on renin and aldosterone in patients with congestive heart failure?

  • Conclusion
    There is limited evidence that an individual with CHF will have an increased plasma renin activity level (PRAL) and aldosterone production rate at lower sodium intakes. The level of sodium intake that is associated with increases in plasma renin activity and aldosterone production rate is not known from the studies analyzed. 
  • Grade: I
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What is the effect of dietary sodium on renin and aldosterone in patients with congestive heart failure?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Cody RJ, Covit AB, Schaer GL, Laragh JH, Sealey JE, Feldschuh J. Sodium and water balance in chronic congestive heart failure. J Clin Invest. 1986; 77: 1,441-1,452.
      • Hummel SL, Seymour M, Brook RD, Kolias TJ, Sheth SS, Rosenblum HR, Wells JM, WEder AB. Low-sodium dietary approaches to stop hypertension diet reduces blood pressure, arterial stiffness, and oxidative stress in hypertensive heart failure with preserved ejection fraction novelty and significance. Hypertension, 2012; 60: 1,200-1,206.
      •  Parrinello G, Pasquale PD, Licata G, Tirres DM Giammanco DM, Fasullo S, Mezzero M, Paterna S. Long-term effects of dietary sodium intake on cytokines and neurohormonal activation in patients with recently compensated congestive heart failure. J Card Fail. 2009; 15(10): 864-873. 
      • Paterna S, Gaspare P, Fasullo S, Sarullo FM, Di Pasquale P. Normal-sodium diet compared with low-sodium diet in compensated congestive heart failure: Is sodium and old enemy or a new friend? Clinical Science. 2008; 114: 221-230.  
      • Paterna S, Parrinello G, Cannizzaro S, Fasullo S, Torress D, Sarullo F, DiPasquale P. Medium term effects of different dosage of diuretic, sodium, and fluid administration on neurohormonal and clinical outcome in patients with recently compensated heart faliure. Am J Cardiol. 2009; 103: 93-102.
      • Riegger GAJ, Kahles HW, Elsner D, Kromer EP, Kochsiek K. Effects of acetylsalicylic acid on renal function in patients with chronic heart failure. Am J Med. 1991, 90: 571-575.
      • Volpe M, Tritto C, DeLuca N, Rubattu S, Rao MAE, Lamenza F, Mirante A, Enea I, Rendina V, Mele AF, Trimarco B, Condorelli M. Abnormalities of sodium handling and of cardiovascular adaptations during high salt diet in patients with mild heart failure. Circulation. 1993; 88: 1,620-1,627.
  • Search Plan and Results: Sodium and CHF
     
  What is the effect of sodium intake on health outcomes in CHF patients?

  • Conclusion
    Limited evidence suggests that a moderate dietary intake of about 2,760mg to 3,000mg per day decreases hospital re-admissions and mortality in patients with compensated CHF when compared to higher or lower intakes. However, it is not clear from the studies analyzed at what level a lower sodium intake would have an unfavorable effect on health outcomes in CHF patients.
  • Grade: II
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What is the effect of sodium intake on health outcomes in CHF patients?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Lennie TA, Song EK, Wu JR, Chung ML, Dunbar SB, Pressler SJ, Moser DK. Three gram sodium intake is associated with longer event-free survival only in patients with advanced heart failure. J Card Fail. 2011; 17(4): 325-330.    
      • O'Donnel MJ, Yusuf S, Mente A, Gao P, Mann JF, Teo K, McQueen M, Sleight P, Sharma AM, Dans A, Probstfield J, Schmieder RE. Urinary sodium and potassium excretion and risk of cardiovascular events. JAMA. 2011: 306 (20): 2,229-2,238.
      • Paterna S, Fasullo S, Parrinello G, Cannizzaro S, Basile I, Vitrano G, Terrazzino G, Maringhini G, Ganci F, Scalzo S, Sarullo FM, Cice G, Di Pasquale P. Short-term effects of hypertonic saline solution in acute heart failure and long-term effects of a moderate sodium restriction in patients with compensated heart failure with New York Heart Association class III (class C) (SMAC-HF study). Am J Med Sci. 2011; 342(1): 27-37.
         
      • Paterna S, Gaspare P, Fasullo S, Sarullo FM, Di Pasquale P. Normal-sodium diet compared with low-sodium diet in compensated congestive heart failure: Is sodium and old enemy or a new friend? Clinical Science. 2008; 114: 221-230.  
      • Paterna S, Parrinello G, Cannizzaro S, Fasullo S, Torress D, Sarullo F, DiPasquale P. Medium term effects of different dosage of diuretic, sodium, and fluid administration on neurohormonal and clinical outcome in patients with recently compensated heart faliure. Am J Cardiol. 2009; 103: 93-102.
      • Son YJ, Lee Y, Song EK. Adherence to a sodium-restricted diet is associated with lower symptom burder and longer cardiac event-free survival in patients with heart failure. J Clinical Nursing. 2011; 20: 3,029-3,038.
      • Song EK. Adherence to the low sodium diet plays a role in the interaction between depressive symptoms and prognosis in patients with heart failure. J Cardiovasc Nurs. 2009; 24 (4): 299-307.
  • Search Plan and Results: Sodium and CHF