심부전 환자에서 적당한 나트륨 섭취 제한

심부전 환자에서 높은 나트륨 섭취가 심부전을 악화시킬 수 있으나, 식이 나트륨을 제한하는 것이 임상 결과에 영향을 미치는지는 여전히 논란이 됩니다.

식이 나트륨을 많이​ 줄이면 심부전 악화가 덜 되는가?

다음 저널은 안정적 심부전 환자 800명 이상을 대상으로

일반적 나트륨 섭취군과 저나트륨섭취군 (<1.5 g/day)으로 무작위 할당하여

모든 원인 사망, 심혈관 관련 입원, 심혈관 관련 응급실 방문을 살펴 본 내용입니다.

두 그룹 간에 차이가 없었습니다.

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따라서 ambulatory HF 환자에게 하루 나트륨 섭취 < 3g/day를 제안합니다 (UpToDate 2022.06.27). 이러한 제안은 >4 g/day의 높은 나트륨 섭취가 해로울 수 있다는 경험적 근거와 <2 g/day의 나트륨 제한이 심부전 재입원을 분명하게 줄이지 못한다는 임상 시험에 근거합니다.

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2022 AHA/ACC/HFSA HF 가이드라인은 AHA/ACC stage C 심부전 환자에서 나트륨을 제한하는 것이 타당하다고 기술하고 있으나 특별한 나트륨 제한을 제안하지 않습니다. 2016 ESC HF 가이드라인은 > 6g/day의 과도한 나트륨 섭취를 피하라고 제안합니다.

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Summary

Background

Dietary restriction of sodium has been suggested to prevent fluid overload and adverse outcomes for patients with heart failure. We designed the Study of Dietary Intervention under 100 mmol in Heart Failure (SODIUM-HF) to test whether or not a reduction in dietary sodium reduces the incidence of future clinical events.

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Methods

SODIUM-HF is an international, open-label, randomised, controlled trial that enrolled patients at 26 sites in six countries (Australia, Canada, Chile, Colombia, Mexico, and New Zealand). Eligible patients were aged 18 years or older, with chronic heart failure (New York Heart Association [NYHA] functional class 2–3), and receiving optimally tolerated guideline-directed medical treatment. Patients were randomly assigned (1:1), using a standard number generator and varying block sizes of two, four, or six, stratified by site, to either usual care according to local guidelines or a low sodium diet of less than 100 mmol (ie, <1500 mg/day). The primary outcome was the composite of cardiovascular-related admission to hospital, cardiovascular-related emergency department visit, or all-cause death within 12 months in the intention-to-treat (ITT) population (ie, all randomly assigned patients). Safety was assessed in the ITT population. This study is registered with ClinicalTrials.gov, NCT02012179, and is closed to accrual.

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Findings

Between March 24, 2014, and Dec 9, 2020, 806 patients were randomly assigned to a low sodium diet (n=397) or usual care (n=409). Median age was 67 years (IQR 58–74) and 268 (33%) were women and 538 (66%) were men. Between baseline and 12 months, the median sodium intake decreased from 2286 mg/day (IQR 1653–3005) to 1658 mg/day (1301–2189) in the low sodium group and from 2119 mg/day (1673–2804) to 2073 mg/day (1541–2900) in the usual care group. By 12 months, events comprising the primary outcome had occurred in 60 (15%) of 397 patients in the low sodium diet group and 70 (17%) of 409 in the usual care group (hazard ratio [HR] 0·89 [95% CI 0·63–1·26]; p=0·53). All-cause death occurred in 22 (6%) patients in the low sodium diet group and 17 (4%) in the usual care group (HR 1·38 [0·73–2·60]; p=0·32), cardiovascular-related hospitalisation occurred in 40 (10%) patients in the low sodium diet group and 51 (12%) patients in the usual care group (HR 0·82 [0·54–1·24]; p=0·36), and cardiovascular-related emergency department visits occurred in 17 (4%) patients in the low sodium diet group and 15 (4%) patients in the usual care group (HR 1·21 [0·60–2·41]; p=0·60). No safety events related to the study treatment were reported in either group.

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Interpretation

In ambulatory patients with heart failure, a dietary intervention to reduce sodium intake did not reduce clinical events.

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Funding

Canadian Institutes of Health Research and the University Hospital Foundation, Edmonton, Alberta, Canada, and Health Research Council of New Zealand.