Restricción de sodio: restricción de sodio para ascitis cirróticas: un metanálisis

OBJECTIVE:

There has been controversial on whether a sodium restricted diet should be used in cirrhotic patients with ascites in recent years. This meta-analysis was aimed to evaluate the beneficial and harmful effects of sodium unrestriction versus sodium restriction for cirrhotic ascites.

METHODS:

We searched relevant randomized controlled trials (RCTs) from CNKI, CBM, VIP, Wangfang, The Cochrane Library, ISI web of knowledge, PUBMED and EMBASE. We traced the related references; searched literatures by Google Scholar and Scirus; hand searched Chinese Journal of Hepatology (1993–2013), Conference Papers and dissertation; contacted all primary authors regarding missed randomised trials. We made quality assessment of qualified RCTs by the Cochrane Handbook 5.1 and used RevMan 5.1 provided by the Cochrane Collaboration to perform meta-analysis.

RESULTS:

Ten literatures come into Meta analysis with two different sodium dose, containing 948 cases in total.(1) Salt intake was restricted to 21–42 mmol per day: Compared with a sodium restricted diet, a free salt diet shows a statistically significant benefit in shortening the time of ascites disappearance and hospitalisation. Complete ascites disappearance, urine volume and average serum sodium are also in favor of a free salt diet. Hyponatremia and HRS occurred less frequently with a free salt diet. No significant differences were seen in the mortality.(2) Salt intake was restricted to 80 mmol per day: The same as in the first sodium dose group, a free salt diet also shows a statistically significant benefit in shortening the time of ascites disappearance and hospitalisation in comparison with a sodium restricted diet. Complete ascites disappearance, urine volume and average serum sodium are also in favor of a free salt diet. Hyponatremia occurred less frequently with a free salt diet. No significant differences were seen in the mortality and the rates of HRS.

CONCLUSION:

Current evidences indicate that a free salt diet can significantly improve the efficiency for cirrhotic ascites in comparison with a sodium restricted diet. Sodium unrestricted diet has a great advantage in shortening the time of ascites disappearance and hospitalisation, increasing urine volume and average serum sodium and decrease the rate of hyponatremia. The results still need to be proved by high quality RCTs.