Comment & Response |

Sodium and Fluid Restriction—Reply

Graziella Aliti, RN, ScD1,2,3; Eneida Rejane Rabelo, RN, ScD1,2,3; Luís Beck-da-Silva, MD, ScD1,3
[+] Author Affiliations
1Heart Failure and Cardiac Transplant Unit, Cardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
2School of Nursing, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
3Postgraduate Program in Cardiology and Cardiovascular Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
JAMA Intern Med. 2014;174(1):163-164. doi:10.1001/jamainternmed.2013.11088.
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In Reply We appreciate the interest by Yeh and Jain in our article and the recognition that it adds more data to the continuing controversy surrounding salt restriction on health. We all know that restricting salt is the current consolidated practice in patients with acute heart failure.1 However, this practice is definitely not evidence based.

Our study is consistent with at least 2 other previous studies that have tested similar interventions.2,3 These studies and ours4 constitute the contemporaneous body of evidence on salt and water restriction in patients with heart failure. We agree with Yeh and Jain that the number of patients in our trial was not large, but when we checked other studies’ numbers, we see that our study sample is actually the largest. These consistencies in data may have contributed in assuming salt and water restriction as “unnecessary.”


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January 1, 2014
James Song-Jeng Yeh, MD; Priyank Jain, MD
1Department of Internal Medicine, Cambridge Health Alliance, Cambridge, Massachusetts2Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
1Department of Internal Medicine, Cambridge Health Alliance, Cambridge, Massachusetts
JAMA Intern Med. 2014;174(1):162-163. doi:10.1001/jamainternmed.2013.11103.
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