{"id":138832,"date":"2025-04-04T22:42:51","date_gmt":"2025-04-05T02:42:51","guid":{"rendered":"https:\/\/cardiologynownews.org\/?p=138832"},"modified":"2025-04-04T22:42:51","modified_gmt":"2025-04-05T02:42:51","slug":"no-benefit-to-fluid-restriction-in-chronic-hf-fresh-up","status":"publish","type":"post","link":"https:\/\/cardiologynownews.org\/?p=138832","title":{"rendered":"No Benefit to Fluid Restriction in Chronic HF: FRESH UP"},"content":{"rendered":"<p><span style=\"font-weight: 400;\">Key Points:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">While fluid restriction is a standard recommendation for patients with chronic heart failure (HF), there is limited evidence to support its use.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">The FRESH-UP trial was designed to examine the utility of fluid restriction vs liberal fluid intake in individuals with NYHA II or III chronic HF.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">There was no difference in symptom burden or safety events between the liberal fluid intake and fluid restriction groups, with an increase in thirst distress in the fluid restriction group.\u00a0<\/span><\/li>\n<\/ul>\n<p><!--more--><\/p>\n<p><span style=\"font-weight: 400;\">While fluid restriction has been considered a cornerstone of HF symptom management, recent observational evidence has questioned its utility. Most consensus guidelines continue to recommend fluid restriction, and clinical trial evidence directly comparing these two strategies has so far been lacking. In a breaking presentation at the 2025 ACC Scientific Sessions today, <\/span><a href=\"https:\/\/esc365.escardio.org\/person\/261024\"><span style=\"font-weight: 400;\">Dr. Roland RJ van Kimmenade<\/span><\/a><span style=\"font-weight: 400;\"> and his team presented their study: \u201cLiberal Fluid Intake versus Fluid Restriction in Chronic Heart Failure,\u201d or the FRESH-UP study, which was simultaneously published in <\/span><a href=\"https:\/\/www.nature.com\/articles\/s41591-025-03628-4\"><span style=\"font-weight: 400;\">Nature Medicine.<\/span><\/a><\/p>\n<p><span style=\"font-weight: 400;\">The FRESH-UP trial <\/span><a href=\"https:\/\/clinicaltrials.gov\/study\/NCT04551729\"><span style=\"font-weight: 400;\">(NCT04551729)<\/span><\/a><span style=\"font-weight: 400;\"> randomized 504 adults across seven medical centers in the Netherlands with a diagnosis of NYHA II\/III chronic HF as per ESC guidelines for at least six months prior to randomization. Relevant exclusion criteria were changes in medical therapy within two weeks of randomization, an admission, PCI, CABG, or device implantation within three months, baseline hyponatremia &lt;130 mmol\/L, or an eGFR &lt; 30mL\/min\/1.73m2. Patients were randomized to liberal fluid intake (ie, no restriction) or fluid restriction of 1.5L a day. The primary outcome was health status at three months as assessed by the Kansas City Cardiomyopathy Questionnaire (KCCQ-OSS). Secondary outcomes included thirst distress at three months, as measured by the Thirst Distress Scale (TDS-HF), as well as death, all-cause hospitalizations, HF hospitalizations, AKI, and reported fluid intake.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">The median age was 69, with 33% women, 98% white individuals, and a mean LVEF of 40%. Prior to randomization, 49% of the liberal fluid intake group and 44% if the fluid restriction group had previously had liberal fluid intake. The average daily Lasix equivalent dose was 40mg a day in each group. There was no significant difference in the primary outcome between the liberal and restrictive strategies at three months (74.0 vs 72.2, p=0.06). On subgroup analyses, a significant p-interaction (p=0.006) was observed for individuals with a median BUN &lt;7.4 mmol\/L vs those without, with more benefit conferred with a liberal fluid intake for those with lower BUN. Thirst distress was higher in the fluid restriction group (18.6 vs 16.9, p&lt;0.001), and fluid intake was, as expected, higher in the liberal than the fluid restriction group (1764 vs 1480ml, p&lt;0.001). No differences were observed in death, all-cause or HF hospitalizations, or AKI.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">When discussing the clinical implications of the study at the Scientific Sessions, Dr. van Kimmenade stated: \u201cDifference in KCCQ-OS after adjustment for baseline scores after three months was 2.17\u2026in favor of liberal fluid intake, but the primary outcome was not met\u2026The FRESH-UP study questions the benefit of fluid restriction in chronic heart failure.\u201d<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Key Points: While fluid restriction is a standard recommendation for patients with chronic heart failure (HF), there is limited evidence to support its use. The FRESH-UP trial was designed to examine the utility of fluid restriction vs liberal fluid intake in individuals with NYHA II or III chronic HF. There was no difference in symptom [&hellip;]<\/p>\n","protected":false},"author":40603,"featured_media":138833,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[898,8],"tags":[899,45,47,185],"ppma_author":[1029],"class_list":{"0":"post-138832","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-acc-2025","8":"category-news","9":"tag-acc-2025","10":"tag-conference","11":"tag-featured","12":"tag-news","13":"author-leah-kosyakovsky"},"authors":[{"term_id":1029,"user_id":40603,"is_guest":0,"slug":"leah-kosyakovsky","display_name":"Leah Kosyakovsky","avatar_url":"https:\/\/secure.gravatar.com\/avatar\/864bde69f6f1f80e91e4a97f0a0ba8daa64c2bb702be09ed787444c7dfa045bb?s=96&r=g","0":null,"1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":""}],"_links":{"self":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/138832","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/users\/40603"}],"replies":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=138832"}],"version-history":[{"count":1,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/138832\/revisions"}],"predecessor-version":[{"id":138834,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/138832\/revisions\/138834"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/media\/138833"}],"wp:attachment":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=138832"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=138832"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=138832"},{"taxonomy":"author","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fppma_author&post=138832"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}