Hydration may reverse most symptoms of lower extremity intermittent claudication or rest pain
Medical treatment of severe intermittent claudication or critical limb-threatening ischemia causing rest pain frequently achieves only partial relief or is not effective at all. Patients with severe intermittent claudication or rest pain of the lower extremities who did not improve after control of...
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| Veröffentlicht in: | Journal of vascular surgery 2020-10, Vol.72 (4), p.1459-1463 |
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| creator | Parodi, Juan Carlos Fernandez, Samuel Moscovich, Fabián Pulmaria, Camilo |
| description | Medical treatment of severe intermittent claudication or critical limb-threatening ischemia causing rest pain frequently achieves only partial relief or is not effective at all.
Patients with severe intermittent claudication or rest pain of the lower extremities who did not improve after control of risk factors, supervised exercises, and cilostazol medication were included in this study. All patients were treated with hydration. They were asked to drink 2500 mL of fluids (water, soup, milk) during a 24-hour period and to ingest 0.6 g/kg of albumin a day, as egg white or albumin powder. Total salt administered daily was 3.5 g. Symptoms, skin temperature, ankle-brachial index, albumin concentration in serum, and time and distance to claudication were recorded before treatment, at 6 weeks, and at 6 months. Electrolytes were measured monthly. No additional treatment was used during the study. Walking was encouraged but not supervised. The trial has continued indefinitely. For statistical analysis, SPSS software (IBM Corp, Armonk, NY) was used. The Ethical Committee approved the protocol, and an informed consent was signed by all patients.
There were 132 patients (94 male, 38 female) included in the study. Median age was 72.5 years (range, 67-77 years); all had severe claudication of a mean of 100 meters or rest pain. Symptoms had been present for >5 months in all patients; 22 (16.8%) had rest pain. Proper hydration, determined as drinking at least 2000 mL of water during 24 hours for a period of 6 months, was achieved in 131 compliant patients. Only one patient failed to drink 2000 mL of water or more. Ankle-brachial index in 131 compliant patients improved from 0.6 to 0.75 (P < .0001) after 6 months. Skin temperature of the feet increased from 29.4°C to 31.7°C (P = .009). Distance to claudication using the treadmill improved from 100 meters to 535 meters (P |
| doi_str_mv | 10.1016/j.jvs.2020.05.066 |
| format | Article |
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Patients with severe intermittent claudication or rest pain of the lower extremities who did not improve after control of risk factors, supervised exercises, and cilostazol medication were included in this study. All patients were treated with hydration. They were asked to drink 2500 mL of fluids (water, soup, milk) during a 24-hour period and to ingest 0.6 g/kg of albumin a day, as egg white or albumin powder. Total salt administered daily was 3.5 g. Symptoms, skin temperature, ankle-brachial index, albumin concentration in serum, and time and distance to claudication were recorded before treatment, at 6 weeks, and at 6 months. Electrolytes were measured monthly. No additional treatment was used during the study. Walking was encouraged but not supervised. The trial has continued indefinitely. For statistical analysis, SPSS software (IBM Corp, Armonk, NY) was used. The Ethical Committee approved the protocol, and an informed consent was signed by all patients.
There were 132 patients (94 male, 38 female) included in the study. Median age was 72.5 years (range, 67-77 years); all had severe claudication of a mean of 100 meters or rest pain. Symptoms had been present for >5 months in all patients; 22 (16.8%) had rest pain. Proper hydration, determined as drinking at least 2000 mL of water during 24 hours for a period of 6 months, was achieved in 131 compliant patients. Only one patient failed to drink 2000 mL of water or more. Ankle-brachial index in 131 compliant patients improved from 0.6 to 0.75 (P < .0001) after 6 months. Skin temperature of the feet increased from 29.4°C to 31.7°C (P = .009). Distance to claudication using the treadmill improved from 100 meters to 535 meters (P < .0001) at 6 weeks and remained stable at 6 month in 65.83% of the patients; in 34.17% of them, distance to claudication increased further by 200 (100-500) meters and time to claudication improved from 1.3 to 6.3 minutes (P < .0001) at 6 weeks, but the same group of patients (34.17%) that increased the distance to claudication further prolonged the time to claudication by 2.49 (1.24-6.23) minutes. All 131 compliant patients improved their status related to lower extremity ischemia; the noncompliant patient did not have any variation of symptoms, skin temperature, ankle-brachial index, or time and distance to claudication. All patients survived the initial 6 months of treatment; afterward, three patients abandoned the treatment and four died of unrelated causes. After the 6-month control, 49% of the patients continued to improve the time and distance to claudication as well as the ankle-brachial index. The rest of the patients conserved the initial improvement. Five patients who had significantly improved the time and distance to claudication were asked to decrease water intake for 3 days. No changes in time and distance to claudication were detected. Hydration was reinitiated.
This study suggests that proper hydration by drinking ≥2000 mL of water daily and albumin complement orally to reach 4 g/dL in serum could be included in the armamentarium of physicians treating patients with disabling claudication or rest pain caused by peripheral artery disease. Further comparative studies to assess the benefit of hydration and increasing the serum oncotic pressure are warranted.</description><identifier>ISSN: 0741-5214</identifier><identifier>EISSN: 1097-6809</identifier><identifier>DOI: 10.1016/j.jvs.2020.05.066</identifier><identifier>PMID: 32972591</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; dehydration ; Drinking ; Female ; Fluid Therapy - methods ; Humans ; Intermittent claudication ; Intermittent Claudication - diagnosis ; Intermittent Claudication - etiology ; Intermittent Claudication - therapy ; Ischemia - diagnosis ; Ischemia - etiology ; Ischemia - therapy ; Lower Extremity - blood supply ; Male ; Pain - etiology ; Pain Management - methods ; Peripheral Arterial Disease - complications ; Peripheral Arterial Disease - therapy ; Prospective Studies ; Rest ; Rest pain ; Severity of Illness Index ; Treatment Outcome</subject><ispartof>Journal of vascular surgery, 2020-10, Vol.72 (4), p.1459-1463</ispartof><rights>2020 Society for Vascular Surgery</rights><rights>Copyright © 2020 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c353t-dde96b78cab3115ae57f7b8f80e6fcc358a788b1e3399205eade842ee333d5273</citedby><cites>FETCH-LOGICAL-c353t-dde96b78cab3115ae57f7b8f80e6fcc358a788b1e3399205eade842ee333d5273</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0741521420314579$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32972591$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Parodi, Juan Carlos</creatorcontrib><creatorcontrib>Fernandez, Samuel</creatorcontrib><creatorcontrib>Moscovich, Fabián</creatorcontrib><creatorcontrib>Pulmaria, Camilo</creatorcontrib><title>Hydration may reverse most symptoms of lower extremity intermittent claudication or rest pain</title><title>Journal of vascular surgery</title><addtitle>J Vasc Surg</addtitle><description>Medical treatment of severe intermittent claudication or critical limb-threatening ischemia causing rest pain frequently achieves only partial relief or is not effective at all.
Patients with severe intermittent claudication or rest pain of the lower extremities who did not improve after control of risk factors, supervised exercises, and cilostazol medication were included in this study. All patients were treated with hydration. They were asked to drink 2500 mL of fluids (water, soup, milk) during a 24-hour period and to ingest 0.6 g/kg of albumin a day, as egg white or albumin powder. Total salt administered daily was 3.5 g. Symptoms, skin temperature, ankle-brachial index, albumin concentration in serum, and time and distance to claudication were recorded before treatment, at 6 weeks, and at 6 months. Electrolytes were measured monthly. No additional treatment was used during the study. Walking was encouraged but not supervised. The trial has continued indefinitely. For statistical analysis, SPSS software (IBM Corp, Armonk, NY) was used. The Ethical Committee approved the protocol, and an informed consent was signed by all patients.
There were 132 patients (94 male, 38 female) included in the study. Median age was 72.5 years (range, 67-77 years); all had severe claudication of a mean of 100 meters or rest pain. Symptoms had been present for >5 months in all patients; 22 (16.8%) had rest pain. Proper hydration, determined as drinking at least 2000 mL of water during 24 hours for a period of 6 months, was achieved in 131 compliant patients. Only one patient failed to drink 2000 mL of water or more. Ankle-brachial index in 131 compliant patients improved from 0.6 to 0.75 (P < .0001) after 6 months. Skin temperature of the feet increased from 29.4°C to 31.7°C (P = .009). Distance to claudication using the treadmill improved from 100 meters to 535 meters (P < .0001) at 6 weeks and remained stable at 6 month in 65.83% of the patients; in 34.17% of them, distance to claudication increased further by 200 (100-500) meters and time to claudication improved from 1.3 to 6.3 minutes (P < .0001) at 6 weeks, but the same group of patients (34.17%) that increased the distance to claudication further prolonged the time to claudication by 2.49 (1.24-6.23) minutes. All 131 compliant patients improved their status related to lower extremity ischemia; the noncompliant patient did not have any variation of symptoms, skin temperature, ankle-brachial index, or time and distance to claudication. All patients survived the initial 6 months of treatment; afterward, three patients abandoned the treatment and four died of unrelated causes. After the 6-month control, 49% of the patients continued to improve the time and distance to claudication as well as the ankle-brachial index. The rest of the patients conserved the initial improvement. Five patients who had significantly improved the time and distance to claudication were asked to decrease water intake for 3 days. No changes in time and distance to claudication were detected. Hydration was reinitiated.
This study suggests that proper hydration by drinking ≥2000 mL of water daily and albumin complement orally to reach 4 g/dL in serum could be included in the armamentarium of physicians treating patients with disabling claudication or rest pain caused by peripheral artery disease. Further comparative studies to assess the benefit of hydration and increasing the serum oncotic pressure are warranted.</description><subject>Aged</subject><subject>dehydration</subject><subject>Drinking</subject><subject>Female</subject><subject>Fluid Therapy - methods</subject><subject>Humans</subject><subject>Intermittent claudication</subject><subject>Intermittent Claudication - diagnosis</subject><subject>Intermittent Claudication - etiology</subject><subject>Intermittent Claudication - therapy</subject><subject>Ischemia - diagnosis</subject><subject>Ischemia - etiology</subject><subject>Ischemia - therapy</subject><subject>Lower Extremity - blood supply</subject><subject>Male</subject><subject>Pain - etiology</subject><subject>Pain Management - methods</subject><subject>Peripheral Arterial Disease - complications</subject><subject>Peripheral Arterial Disease - therapy</subject><subject>Prospective Studies</subject><subject>Rest</subject><subject>Rest pain</subject><subject>Severity of Illness Index</subject><subject>Treatment Outcome</subject><issn>0741-5214</issn><issn>1097-6809</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kE1PxCAURYnR6PjxA9wYlm5agZZC48oYvxITN7o0hMJrwqQtIzCj_fcyGXXpikdy7nlwETqnpKSENlfLcrmJJSOMlISXpGn20IKSVhSNJO0-WhBR04IzWh-h4xiXhFDKpThERxVrBeMtXaD3x9kGnZyf8KhnHGADIQIefUw4zuMq-TFi3-PBf0LA8JUCjC7N2E0JQp4STAmbQa-tMzuND9mS0yvtplN00OshwtnPeYLe7u9ebx-L55eHp9ub58JUvEqFtdA2nZBGd1V-ogYuetHJXhJoepMZqYWUHYWqaltGOGgLsmaQ75XlTFQn6HLnXQX_sc7b1eiigWHQE_h1VKyum4a3tWQZpTvUBB9jgF6tght1mBUlatuqWqrcqtq2qghXudWcufjRr7sR7F_it8YMXO8AyJ_cOAgqGgeTAesCmKSsd__ovwEWm4pS</recordid><startdate>202010</startdate><enddate>202010</enddate><creator>Parodi, Juan Carlos</creator><creator>Fernandez, Samuel</creator><creator>Moscovich, Fabián</creator><creator>Pulmaria, Camilo</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202010</creationdate><title>Hydration may reverse most symptoms of lower extremity intermittent claudication or rest pain</title><author>Parodi, Juan Carlos ; Fernandez, Samuel ; Moscovich, Fabián ; Pulmaria, Camilo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c353t-dde96b78cab3115ae57f7b8f80e6fcc358a788b1e3399205eade842ee333d5273</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Aged</topic><topic>dehydration</topic><topic>Drinking</topic><topic>Female</topic><topic>Fluid Therapy - methods</topic><topic>Humans</topic><topic>Intermittent claudication</topic><topic>Intermittent Claudication - diagnosis</topic><topic>Intermittent Claudication - etiology</topic><topic>Intermittent Claudication - therapy</topic><topic>Ischemia - diagnosis</topic><topic>Ischemia - etiology</topic><topic>Ischemia - therapy</topic><topic>Lower Extremity - blood supply</topic><topic>Male</topic><topic>Pain - etiology</topic><topic>Pain Management - methods</topic><topic>Peripheral Arterial Disease - complications</topic><topic>Peripheral Arterial Disease - therapy</topic><topic>Prospective Studies</topic><topic>Rest</topic><topic>Rest pain</topic><topic>Severity of Illness Index</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Parodi, Juan Carlos</creatorcontrib><creatorcontrib>Fernandez, Samuel</creatorcontrib><creatorcontrib>Moscovich, Fabián</creatorcontrib><creatorcontrib>Pulmaria, Camilo</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of vascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Parodi, Juan Carlos</au><au>Fernandez, Samuel</au><au>Moscovich, Fabián</au><au>Pulmaria, Camilo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Hydration may reverse most symptoms of lower extremity intermittent claudication or rest pain</atitle><jtitle>Journal of vascular surgery</jtitle><addtitle>J Vasc Surg</addtitle><date>2020-10</date><risdate>2020</risdate><volume>72</volume><issue>4</issue><spage>1459</spage><epage>1463</epage><pages>1459-1463</pages><issn>0741-5214</issn><eissn>1097-6809</eissn><abstract>Medical treatment of severe intermittent claudication or critical limb-threatening ischemia causing rest pain frequently achieves only partial relief or is not effective at all.
Patients with severe intermittent claudication or rest pain of the lower extremities who did not improve after control of risk factors, supervised exercises, and cilostazol medication were included in this study. All patients were treated with hydration. They were asked to drink 2500 mL of fluids (water, soup, milk) during a 24-hour period and to ingest 0.6 g/kg of albumin a day, as egg white or albumin powder. Total salt administered daily was 3.5 g. Symptoms, skin temperature, ankle-brachial index, albumin concentration in serum, and time and distance to claudication were recorded before treatment, at 6 weeks, and at 6 months. Electrolytes were measured monthly. No additional treatment was used during the study. Walking was encouraged but not supervised. The trial has continued indefinitely. For statistical analysis, SPSS software (IBM Corp, Armonk, NY) was used. The Ethical Committee approved the protocol, and an informed consent was signed by all patients.
There were 132 patients (94 male, 38 female) included in the study. Median age was 72.5 years (range, 67-77 years); all had severe claudication of a mean of 100 meters or rest pain. Symptoms had been present for >5 months in all patients; 22 (16.8%) had rest pain. Proper hydration, determined as drinking at least 2000 mL of water during 24 hours for a period of 6 months, was achieved in 131 compliant patients. Only one patient failed to drink 2000 mL of water or more. Ankle-brachial index in 131 compliant patients improved from 0.6 to 0.75 (P < .0001) after 6 months. Skin temperature of the feet increased from 29.4°C to 31.7°C (P = .009). Distance to claudication using the treadmill improved from 100 meters to 535 meters (P < .0001) at 6 weeks and remained stable at 6 month in 65.83% of the patients; in 34.17% of them, distance to claudication increased further by 200 (100-500) meters and time to claudication improved from 1.3 to 6.3 minutes (P < .0001) at 6 weeks, but the same group of patients (34.17%) that increased the distance to claudication further prolonged the time to claudication by 2.49 (1.24-6.23) minutes. All 131 compliant patients improved their status related to lower extremity ischemia; the noncompliant patient did not have any variation of symptoms, skin temperature, ankle-brachial index, or time and distance to claudication. All patients survived the initial 6 months of treatment; afterward, three patients abandoned the treatment and four died of unrelated causes. After the 6-month control, 49% of the patients continued to improve the time and distance to claudication as well as the ankle-brachial index. The rest of the patients conserved the initial improvement. Five patients who had significantly improved the time and distance to claudication were asked to decrease water intake for 3 days. No changes in time and distance to claudication were detected. Hydration was reinitiated.
This study suggests that proper hydration by drinking ≥2000 mL of water daily and albumin complement orally to reach 4 g/dL in serum could be included in the armamentarium of physicians treating patients with disabling claudication or rest pain caused by peripheral artery disease. Further comparative studies to assess the benefit of hydration and increasing the serum oncotic pressure are warranted.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>32972591</pmid><doi>10.1016/j.jvs.2020.05.066</doi><tpages>5</tpages></addata></record> |
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| source | MEDLINE; Elsevier ScienceDirect Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
| subjects | Aged dehydration Drinking Female Fluid Therapy - methods Humans Intermittent claudication Intermittent Claudication - diagnosis Intermittent Claudication - etiology Intermittent Claudication - therapy Ischemia - diagnosis Ischemia - etiology Ischemia - therapy Lower Extremity - blood supply Male Pain - etiology Pain Management - methods Peripheral Arterial Disease - complications Peripheral Arterial Disease - therapy Prospective Studies Rest Rest pain Severity of Illness Index Treatment Outcome |
| title | Hydration may reverse most symptoms of lower extremity intermittent claudication or rest pain |
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