Zou CL. Letter to the Editor: Revisiting salt restriction in hyponatremic cirrhosis - a paradigm in need of refinement? World J Methodol 2026; 16(3): 118971 [DOI: 10.5662/wjm.118971]
Corresponding Author of This Article
Cheng-Long Zou, PhD, Postdoctoral Fellow, Department of Neurosurgery, Xinqiao Hospital, Army Medical University, No. 83 Xinqiao Zheng Street, Shapingba District, Chongqing 400037, China. edwardzcl@pku.edu.cn
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Health Care Sciences & Services
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letter
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Zou CL. Letter to the Editor: Revisiting salt restriction in hyponatremic cirrhosis - a paradigm in need of refinement? World J Methodol 2026; 16(3): 118971 [DOI: 10.5662/wjm.118971]
World J Methodol. Sep 20, 2026; 16(3): 118971 Published online Sep 20, 2026. doi: 10.5662/wjm.118971
Letter to the Editor: Revisiting salt restriction in hyponatremic cirrhosis - a paradigm in need of refinement?
Cheng-Long Zou
Cheng-Long Zou, Department of Neurosurgery, Xinqiao Hospital, Army Medical University, Chongqing 400037, China
Author contributions: Zou CL completed the writing of the manuscript, data analysis, and review approval.
Supported by the National Key Research and Development Program of China, No. 2024YFC2607404.
Conflict-of-interest statement: The author reports no relevant conflicts of interest for this article.
Corresponding author: Cheng-Long Zou, PhD, Postdoctoral Fellow, Department of Neurosurgery, Xinqiao Hospital, Army Medical University, No. 83 Xinqiao Zheng Street, Shapingba District, Chongqing 400037, China. edwardzcl@pku.edu.cn
Received: January 16, 2026 Revised: March 6, 2026 Accepted: April 9, 2026 Published online: September 20, 2026 Processing time: 176 Days and 2.4 Hours
Abstract
The management of decompensated cirrhosis is fraught with clinical dilemmas, often requiring a delicate balance between opposing physiological principles. One such enduring controversy is the role of dietary sodium restriction, long considered a cornerstone in the management of ascites and fluid overload. The study by Marrapu et al published in the World Journal of Methodology, directly challenges this convention in a specific and vulnerable population: Patients with cirrhosis and moderate to severe hyponatremia. Their open-label randomized controlled trial provides compelling evidence that a salt-restricted diet (5 g/day) may be harmful compared to a more liberal, salt-unrestricted diet (10 g/day), associating salt-restricted diet with a significantly higher risk of acute kidney injury, poorer nutritional and hemodynamic profiles, and increased short-term mortality, without offering a clear benefit in ascites control.
Core Tip: This study serves as a critical catalyst for re-evaluating a decades-old dietary dogma. It suggests that in cirrhotic patients with moderate to severe hyponatremia, automatic sodium restriction may inadvertently accelerate the path to renal injury, sarcopenia, and death. A more tailored, physiology-guided dietary strategy that prioritizes renal perfusion and nutritional preservation is urgently needed. This underscores the need for more individualized dietary strategies, particularly in this vulnerable patient population.
