Prescribed in-hospital sodium intake for decompensated heart failure: A systematic review and meta-analysis

Background: Standard inpatient management of acute decompensated heart failure (ADHF) has included restricted dietary sodium. Sodium supplementation with diuretics has been proposed as an alternative to treat ADHF in an inpatient setting. Objectives: We conducted a systematic review to evaluate prescribed oral and/or intravenous sodium supplementation (with diuretics), to patients hospitalized for ADHF. Methods: We searched Medline, Embase, ClinicalTrials.gov, CINAHL, and Cochrane Database of Systematic Reviews from inception to September 24, 2024, for randomized controlled trials (RCTs), and nonrandomized comparative studies (NRCSs) reporting intermediate, clinical, or health service use outcomes for ADHF inpatients. We assessed risk of bias, and where there were at least three studies reporting results from similar analyses, we conducted meta-analyses. GRADE methodology was used to assess the strength of evidence. Results: Fourteen RCTs and two NRCSs compared supplemental sodium with furosemide to furosemide alone. Supplemental sodium with furosemide significantly decreased serum creatinine (pooled net mean difference [NMD]: −0.33 mg/dL, 95% confidence interval [CI]: [−0.50 to −0.17]), brain natriuretic peptide (pooled NMD: −62.84 pg/mL, 95% CI: [−103.61 to −22.08]), and weight (pooled NMD: −2.48 kg, 95% CI: [−4.31 to −0.66]). There were no significant differences in N-terminal pro b-type natriuretic peptide (pooled NMD: −1614 pg/mL, 95% CI: [−3582 to 353]). There was a significant decrease in length of hospital stay (pooled MD: −2.68 days, 95% CI: [−3.81 to −1.55]). Studies provided insufficient evidence on mortality and readmission outcomes, and no evidence for caloric intake or clinical congestion score. Conclusions: Sodium supplementation with diuretics may improve kidney function, promote weight loss, and shorten length of hospital stay.