(P185) THE RELATIONSHIP OF DIURETICS AND DIETARY SODIUM IN PATIENTS WITH HEART FAILURE: AN ANALYSIS OF THE SODIUM-HF TRIAL

Background: SODIUM-HF was a large clinical trial testing dietary sodium restriction compared to usual care in patients with heart failure that showed no reduction in clinical events. It has been suggested that diuretic doses in response to dietary sodium modification may have influenced the trial results.

Objective: We assessed the effects of baseline diuretic dose and diuretic dose changes on clinical outcomes in the SODIUM-HF trial.

METHODS AND RESULTS: Diuretics were converted to furosemide-equivalent diuretic total daily doses. Furosemide dose was treated as a continuous variable and also stratified into 0 mg, 1–39 mg, 40 mg, 41–80 mg, and >80 mg daily. The baseline diuretic dose and change in diuretic dose were assessed and correlated with dietary sodium restriction and changes in dietary sodium intake. We examined the relationship between diuretic dosing and the primary outcome of SODIUM-HF (cardiovascular-related ED visit, cardiovascular-related hospitalization, and all-cause mortality).

Of the 806 patients enrolled in the SODIUM-HF trial, 784 had known diuretic status at baseline: 209 patients (26.7%) with 0 mg, 134 patients (17%) with 1-39 mg, 205 patients (26.1%) with 40 mg, 118 patients (15.1%) with 41-80mg, and 118 patients (15.1%) >80 mg. No correlation was found between dietary sodium intake and diuretic dose either at baseline or throughout the trial. For the primary outcome, in both trial arms, the 2-year risk of primary outcome was strongly correlated with baseline diuretic dose (Figure 1a, p< 0.001). No correlation was found between dietary sodium intake and diuretic dose either at baseline or during the trial. No significant association was demonstrated between the primary outcome and change in diuretic dose, or between the primary outcome and baseline diuretic dose when comparing usual care and dietary sodium restriction (Figure 1b, p>0.05).

Conclusion: A higher baseline diuretic dose was associated with worse clinical outcomes in both arms of the trial. However, changes in diuretic dose or dietary sodium were not associated with a difference in primary outcomes when comparing usual care and dietary sodium restriction.