Restricted Daily Sodium Intake as Heart Failure Management: A Systematic Review


  • Kiara Hanna Quinncilla Sebelas Maret University
  • Eric Raditya Kaminto Universitas Tarumanagara
  • Melani Limenco Benly Universitas Tarumanagara
  • Anisa Rizmi Lausiri Universitas Tarumanagara
  • Andreas Adiwinata Then Universitas Tarumanagara
  • Rara Poetri Claudya Universitas Tarumanagara
  • Hartanto Hartanto Universitas Tarumanagara
  • Muhammad Juni Akbar Universitas Tarumanagara
  • Christobal Anugerah Tanisa Universitas Tarumanagara
  • Nafisa Zulpa Elhapidi Universitas Tarumanagara



Heart failure, Hypertension, Management, New York heart association (NYHA) functional class, Sodium restriction


Objective: To evaluate mortality and morbidity in HF patients receiving sodium restriction.

Study Design: Systematic Literature Review (SLR) of RCTs and Cohort studies worldwide published between Jan 2013 to Jan 2023.

Methodology: We systematically selected RCTs and Cohort studies with sodium restriction as an intervention published within the last decade from five databases (PubMed, Scopus, Cochrane Library, Embase, and Medline). The full texts retrieved were assessed for risk of bias, and then a systematic review was performed. The endpoints analyzed were mortality and morbidity.

Result: Five RCTs and two cohort studies were included in this study, with 2,505 participants. The endpoints retrieved were mortality and morbidity (hospitalization, NYHA functional class, BNP or NT-proBNP level, quality of life, and congestion). No improvement was seen in mortality and hospitalization, but sodium restriction improved the rest of the morbidity indicators. Over-restricted and overconsumption of sodium intake might worsen HF presentation. When analyzed based on the HF groups, there was not enough evidence to recommend sodium dose based on ejection fraction; however, there was potentially more benefit for patients with higher NYHA classes. However, more evidence is still needed.

Conclusion: Sodium restriction did not benefit mortality and hospitalization but improved quality of life, systolic blood pressure, and BNP or NT-pro BNP levels in all HF classes.


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Savarese G, Lund LH. Global Public Health Burden of Heart Failure. Card Fail Rev 2017 ; 3(1): 7-11.

Lam CSP. Heart failure in Southeast Asia: facts and numbers. ESC Heart Fail 2015 ; 2(2): 46-49.

Emmons-Bell S, Johnson C, Roth G. Prevalence, incidence and survival of heart failure: a systematic review. Heart 2022 ;108(17):1351-1360.

Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, et al. American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association. Circulation 2017; 135(10): e146-e603.

Gupta D, Georgiopoulou VV, Kalogeropoulos AP, Dunbar SB, Reilly CM, Sands JM, et al. Dietary sodium intake in heart failure. Circulation 2012 ; 126(4): 479-85.

Aggarwal M, Bozkurt B, Panjrath G, Aggarwal B, Ostfeld RJ, Barnard ND, et al. American College of Cardiology’s Nutrition and Lifestyle Committee of the Prevention of Cardiovascular Disease Council. Lifestyle Modifications for Preventing and Treating Heart Failure. J Am Coll Cardiol 2018;72(19):2391-2405.

Patel Y, Joseph J. Sodium Intake and Heart Failure. Int J Mol Sci 2020;21(24):9474.

Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Drazner MH, et al. American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation 2013; 128(16): e240-327.

Machado d'Almeida KS, Rabelo-Silva ER, Souza GC, Trojahn MM, Santin Barilli SL, Aliti G, et al. Aggressive fluid and sodium restriction in decompensated heart failure with preserved ejection fraction: Results from a randomized clinical trial. Nutrition 2018 ;54:111-117.

Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD; et al. Cochrane Bias Methods Group; Cochrane Statistical Methods Group. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 2011;343:d5928.

Luchini C, Stubbs B, Solmi M, Veronese N. Assessing the quality of studies in meta-analyses: Advantages and limitations of the Newcastle Ottawa Scale. World J Meta-Anal2017; 5(4): 80-84.

Li J, Zhen Z, Huang P, Dong YG, Liu C, Liang W. Salt restriction and risk of adverse outcomes in heart failure with preserved ejection fraction. Heart 2022;108(17):1377-1382.

Ivey-Miranda JB, Almeida-Gutierrez E, Herrera-Saucedo R, Posada-Martinez EL, Chavez-Mendoza A, Mendoza-Zavala GH, et al. Sodium restriction in patients with chronic heart failure and reduced ejection fraction: A randomized controlled trial. Cardiol J 2023;30(3):411-421.

Kalogeropoulos A, Papadimitriou L, Georgiopoulou VV, Dunbar SB, Skopicki H, Butler J, et al. Low- Versus Moderate-Sodium Diet in Patients With Recent Hospitalization for Heart Failure: The PROHIBIT (Prevent Adverse Outcomes in Heart Failure by Limiting Sodium) Pilot Study. Circ Heart Fail 2020 ;13(1):e006389.

Doukky R, Avery E, Mangla A, Collado FM, Ibrahim Z, Poulin MF, et al. Impact of Dietary Sodium Restriction on Heart Failure Outcomes. JACC Heart Fail 2016;4(1):24-35.

Colin-Ramirez E, McAlister FA, Zheng Y, Sharma S, Armstrong PW, Ezekowitz JA, et al. The long-term effects of dietary sodium restriction on clinical outcomes in patients with heart failure. The SODIUM-HF (Study of Dietary Intervention Under 100 mmol in Heart Failure): a pilot study. Am Heart J 2015;169(2):274-281.e1.

Song EK, Moser DK, Dunbar SB, Pressler SJ, Lennie TA. Dietary sodium restriction below 2 g per day predicted shorter event-free survival in patients with mild heart failure. Eur J Cardiovasc Nurs 2014 ;13(6): 541-548.

Philipson H, Ekman I, Forslund HB, Swedberg K, Schaufelberger M. Salt and fluid restriction is effective in patients with chronic heart failure. Eur J Heart Fail 2013;15(11):1304-1310.

Colin-Ramirez E, Arcand J, Ezekowitz JA. Dietary Self-management in Heart Failure: High Tech or High Touch? Curr Treat Options Cardiovasc Med 2017;19(3):19.

DiNicolantonio JJ, Chatterjee S, O'Keefe JH. Dietary Salt Restriction in Heart Failure: Where Is the Evidence? Prog Cardiovasc Dis 2016 ; 58(4): 401-406.

Konerman MC, Hummel SL. Sodium restriction in heart failure: benefit or harm? Curr Treat Options Cardiovasc Med 2014; 16(2): 286.

Yancy CW. The Uncertainty of Sodium Restriction in Heart Failure: We Can Do Better Than This. JACC Heart Fail 2016; 4(1): 39-41.

Reilly CM, Anderson KM, Baas L, Johnson E, Lennie TA, Lewis CM, et al. American Association of Heart Failure Nurses Best Practices paper: Literature synthesis and guideline review for dietary sodium restriction. Heart Lung 2015; 44(4): 289-298.

Khan MS, Jones DW, Butler J. Salt, No Salt, or Less Salt for Patients With Heart Failure? Am J Med 2020; 133(1): 32-38.

Wang K, Chu C, Hu J, Wang Y, Zheng W, Lv Y, et al. Effect of Salt Intake on the Serum Cardiotrophin-1 Levels in Chinese Adults. Ann Nutr Metab 2018;7 3(4): 302-309.

Rakova N, Kitada K, Lerchl K, Dahlmann A, Birukov A, Daub S, et al. Increased salt consumption induces body water conservation and decreases fluid intake. J Clin Invest 2017; 127(5): 1932-1943.




How to Cite

Quinncilla KH, Kaminto ER, Benly ML, Lausiri AR, Then AA, Claudya RP, et al. Restricted Daily Sodium Intake as Heart Failure Management: A Systematic Review. Pak Armed Forces Med J [Internet]. 2024 Apr. 29 [cited 2024 May 24];74(2):566-73. Available from:



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