The effect of sodium restricted diet on the prognosis of heart failure patients: a systemic review and meta-analysis

Aims To evaluate whether a sodium restricted diet can improve the prognosis of HF patients. Methods Retrieve for randomized controlled trials (RCTs) on sodium restricted diets for HF patients from PubMed, Web of Science, Cochrane Library and Embase, with a retrieval period from the establishment of databases to July 2025. Two researchers independently conducted literature screening using RevMan 5.4 and evaluated the quality using Cochrane risk of bias tool. Finally, StataMP 18 was used for meta-analysis. Results 16 RCTs were included, with 2260 patients. The meta-analysis results showed that compared with the control group, the sodium restricted diet group had significantly increased all-cause mortality rate (RR 1.50 [95%CI: 1.05–2.14] I 2 =0) and cardiac mortality rate (RR 2.51 [95%CI: 1.55–4.05] I 2 =7.5%), while there was no statistically significant difference in HF readmission rate and all-cause readmission rate between the two groups ( p > 0.05). Subgroup analyses showed that in the subgroup of HFrEF patients and the subgroup that simultaneously restricted fluid intake and used diuretics, the sodium restricted diet was associated with an increased risk of all-cause death and HF readmission. Descriptive analyses showed that a sodium restricted diet might improve patients' quality of life, but had no significant effect on serum NT-proBNP level. Conclusion Although sodium restriction may improve the quality of life of HF patients, it is not associated with a reduced risk of readmission or lower the serum NT-proBNP level; for HFrEF patients receiving diuretic therapy and fluid restriction, the sodium restricted diet is associated with an increased risk of all-cause mortality and HF readmission.