Increased hydration may improve symptoms of claudication, rest pain

HOLLYWOOD, Fla. — Among patients with claudication with or without pain at rest who did not respond to medical therapy, a strategy of increasing water consumption to more than 2.5 L per day improved symptoms, according to research presented at the International Symposium on Endovascular Therapy.

The idea to vastly increase hydration in this patient population occurred after it improved the condition of two patients who had exhausted medical and surgical options, Juan Carlos Parodi, MD, chief of surgery at University of Buenos Aires and Trinidad Hospital, said during a presentation.

“The common factor in both patients was dehydration,” Parodi said. “So, we organized a prospective trial of increased water consumption in patients with claudication and/or rest pain who did not respond to standard treatment.”

The trial enrolled 52 patients (median age, 76 years; 63% men) with no response to medical therapy over 6 months and without a history of congestive HF or renal insufficiency. All patients continued existing medical therapy, underwent a complete physical examination and researchers recorded ankle-brachial index, time and distance to claudication, subjective pain sensation and cutaneous temperature at baseline, 6 weeks and 6 months.

Patients were advised to consume 3 L of water per day. All reported previously consuming only one or two glasses of water per day, Parodi said.

“In the last 2 months, we adopted the policy of increasing the serum albumin with the ingestion of egg yolk,” Parodi told Cardiology Today’s Intervention. “If albumin is above 4 g per dL, water intake doesn’t need to be more than 2.5 liters per day. We also added 3.5 g of salt per day.”

Among 51 patients who complied with the protocol, the researchers reported an increase in skin temperature of the foot (P = .0454), time and distance to claudication (P < .0001), and ankle-brachial index (P < .0001) and a decrease in subjective pain sensation on a scale of 1 to 10 (P < .0001) at 6 weeks. Parodi said all improvements were maintained at 6 months.

In addition, at the 6-month follow-up, patients with cognitive deficits and visual impairment showed improvement in those symptoms. The researchers also observed reversal of syncope in one patient, reversal of intestinal ischemia in two patients and improvement in stable cardiac ischemia in two patients, Parodi said during the presentation.

“Dehydration is common in elderly patients: 1 in 10 admissions to [U.S.] hospitals are because of dehydration, and elderly people drink less fluids because of thirst decrease,” he said. “Most of the elderly patients with intermittent claudication were drinking a low volume of water. All patients responded to an increase of water intake. In the last 12 months, our cases of angioplasty and/or stenting dropped almost 90%.” – by Erik Swain

Reference:

Parodi JC. Saving lives and limbs: The critical role of medical therapy in PAD today and tomorrow. Presented at: the International Symposium on Endovascular Therapy (ISET); Jan. 27-30, 2019; Hollywood, Fla.

Disclosure: Parodi reports no relevant financial disclosures