Open-label randomized controlled study of salt-restricted <i>vs</i> salt-unrestricted diet in patients with cirrhosis with hyponatremia

BACKGROUND: Salt restriction is commonly recommended for patients with cirrhosis to manage ascites; however, its safety and efficacy in patients with hyponatremia remain unclear. AIM: a salt-unrestricted diet (SUD; 10 g/day) on renal, nutritional, and hemodynamic outcomes, as well as short-term mortality in patients with cirrhosis with moderate to severe hyponatremia. METHODS: A total of 150 patients with serum sodium < 130 mEq/L were randomized to either SRD or SUD. After excluding patients who died, were non-adherent, or were lost to follow-up within 4 weeks, 105 participants (SRD: 51; SUD: 54) were included in the outcomes analysis. The primary outcome was the incidence of acute kidney injury (AKI) over 6 months; secondary outcomes included ascites control, nutritional markers, and mortality. RESULTS: = 0.009), and survival analysis consistently favored SUD. CONCLUSION: Salt restriction in patients with cirrhosis with moderate to severe hyponatremia may predispose them to renal dysfunction, nutritional decline, and increased short-term mortality without providing a clear benefit in ascites control. These findings underscore the need for individualized sodium recommendations in patients with advanced cirrhosis.