Sodium restriction in chronic heart failure: a systematic review and meta-analysis
What it found
In people with chronic heart failure, restricting dietary sodium was linked to a higher risk of death or hospitalisation together, but made no clear difference to death alone or hospital stays for heart failure.
What they found
Studies in people
Death from any cause
Across 8 studies with 2140 people, 11.07% of those on a sodium-restricted diet died compared with 8.31% on a sodium-liberal diet. The difference was not statistically significant.
Heart failure hospital stays
In 6 studies with 1211 people, 33.71% of the sodium-restricted group were hospitalised for heart failure compared with 25.96% of the sodium-liberal group. The difference was not statistically significant.
Death or hospitalisation combined
In 3 studies with 475 people, 49.16% of the sodium-restricted group died or were hospitalised compared with 16.04% of the sodium-liberal group. Sodium restriction was linked to a higher risk of this combined outcome.
Kidney function marker
In 4 studies with 541 people, blood creatinine at the end of follow-up was on average 0.34 mg/dL higher in the sodium-restricted group, but this difference was not statistically significant.
Year of publication
The year a study was published was linked to the size of the effect on heart failure hospital stays, suggesting sodium restriction may have been more harmful in the past than more recently.
What the authors conclude
“In a meta-analysis, sodium restriction in CHF patients worsened the prognosis in terms of a composite of mortality and hospitalizations and did not influence all-cause mortality and HF hospitalisation rate.”
Also in their conclusions
- They conclude that sodium restriction in chronic heart failure patients worsened the prognosis in terms of a composite of mortality and hospitalisations and did not influence all-cause mortality and HF hospitalisation rate.
- They advise that doctors should focus on recommendations with reliable, evidence-based effects and try to eliminate unreasonable ones that may distract patients from essential advice.
- They call for further trials, especially in patients taking SGLT2 inhibitors and in those with heart failure with preserved ejection fraction, to clarify the role of dietary sodium.
How it was done
Sodium restriction has long been recommended for heart failure patients, but the evidence behind it is weak and some recent studies suggest it may not help and could even be harmful.
The authors pooled 9 studies with 2210 adults with chronic heart failure, including 5 randomised trials, 2 prospective cohort studies and 2 registry analyses. Patients were followed for 12 weeks to 3 years, with an average follow-up of 15.77 months.
What it can’t tell you
- The included studies were very different from each other in design, follow-up time, population and amount of sodium restriction, which makes the combined results less certain.
- The quality of evidence from the observational studies was very low, and for heart failure hospitalisation in randomised trials it was also very low.
- This review cannot show what happens in people with acute heart failure or in those taking newer heart failure medicines like SGLT2 inhibitors.
Who paid
- Conflicts
- Prof. Piotr Ponikowski has received personal fees for consultancy and Speakers Bureau from AstraZeneca, Boehringer Ingelheim, Vifor Pharma, Servier, Bayer, Bristol Myers Squibb, Respocardia, Berlin-Chemie, Cibiem, Novartis, and Renal Guard; other support for participation in clinical trials from Boehringer Ingelheim, Amgen, Vifor Pharma, Bayer, Bristol Myers Squibb, Cibiem, Novartis, and RenalGuard; and research grants to his institution from Vifor Pharma. All other authors have no conflicts of interest to declare that are relevant to the content of this article.
- Authors work at
- Wroclaw Medical University, Poland
The paper
- Title
- Role of dietary sodium restriction in chronic heart failure: systematic review and meta-analysis
- Type
- Systematic review and meta-analysisThe authors follow a set, published method to find every relevant study, then combine the numbers from them into one result.
- Evidence
- Studies in people
- Summarised from
- Full text
- Cite
- Urban S, Fułek M, Błaziak M, et al (2024). Role of dietary sodium restriction in chronic heart failure: systematic review and meta-analysis. Clinical research in cardiology. doi:10.1007/s00392-023-02256-7Free full textPubMed 37389661DOI
Summary written 26 Sep 2026. Check it against the paper before it changes what you eat. How we summarise papers · Report an error