Diuretic pattern in adults with nocturnal polyuria: The possible contribution of blood pressure to the worsening of nocturnal polyuria

Abstract

Aim: The present study was undertaken to investigate diuresis rate determinants of nocturnal polyuria (NP) in adults. Subjects and Methods: A total of 33 patients aged 50-87 years (mean: 68.6), with nocturnal urine volumes exceeding 10 mL per kg body weight based on records of a frequency-volume chart, were enrolled to evaluate the relationships between diuresis rates and related variables. Multiple regression analyses were conducted to identify diuresis rate determinants, including brain natriuretic peptide. Furthermore, a hypertonic saline infusion test was conducted to examine the arginine vasopressin (AVP) response to plasma osmotic change. Results: Nocturnal voids correlated negatively with the daytime diuresis rate (P = 0.019). Despite a similar total urine volume per kg body weight (TUV/kgBw), systolic and mean blood pressure (MBP) significantly correlated with the nocturnal diuresis rate positively and the daytime diuresis rate negatively. The MBP, which was selected as a representative variable for blood pressure, was found to be an independent determinant for the nocturnal. The MBP and TUV/kgBw were independent determinants for the daytime diuresis rate on multiple regression analyses. Neither age, AVP, nor brain natriuretic peptide were determinants for them. When divided into two groups using their median nocturnal diuresis rates (0.023 mL/kg/min), there was no difference in the prevalence of stroke and the taking of hypnotics between the groups. Overall, a hypervolemic condition or increased sympathetic nerve activity in NP was suggested using the hypertonic saline infusion test. Conclusions: These results indicate that blood pressure might play an important role as a determinant of increasing nocturnal diuresis in NP.

Independent Associations Between Nocturia and Nighttime Blood Pressure/Dipping in Elderly Individuals: The HEIJO‐KYO Cohort

“…In the present study, sleep architectures were not measured; moreover, causality of the association between nocturia and ABP cannot be ascertained because the present study was cross‐sectional. Also, a possible contribution of high blood pressure on nocturia has been reported, and natriuretic peptide may mediate it . Further research is needed to better understand whether improvement of nocturia decreases nighttime BP and increases dipping.…”

Lower urinary tract symptoms and their impact on quality of life after successful renal transplantation

“…Regarding age, nocturia caused by nocturnal polyuria is generally a common complaint in the elderly, because day to night ratios of urinary excretion gradually reduce with age, which may be implicated in cardiac function, hormonal changes such as arginine vasopressin secretion and so on. [17][18][19] Hypertension, which is common in elderly patients, is also related to increasing nocturnal diuresis. 18,19 Meanwhile, in periods of dialysis before RTX, autonomic dysfunction, which patients with uremia receiving dialysis commonly have, 20 may be implicated in nocturnal polyuria.…”

“…[17][18][19] Hypertension, which is common in elderly patients, is also related to increasing nocturnal diuresis. 18,19 Meanwhile, in periods of dialysis before RTX, autonomic dysfunction, which patients with uremia receiving dialysis commonly have, 20 may be implicated in nocturnal polyuria. Thus, age and periods of dialysis before RTX could affect nocturnal polyuria after RTX.…”

Fluid control in elderly patients with nocturia

“…A hypertonic saline infusion test, one of the practical evaluation methods of hypothalamo-hypophyseal function, was conducted to examine the plasma AVP release responsiveness of the hypothalamoposterior pituitary system to osmolality changes of increased plasma sodium in patients with NP. 13,24,25 For this test, a 5% hypertonic saline infusion was given at a rate of 0.05 mL/kg per min for 120 min on 31 patients in the NP group and eight patients in the non-NP group. All of the patients were in a recumbent position while the test was being conducted.…”

“…Recently there have been reports indicating that the link between nocturia and cardiovascular disorders has clinical implications 8–10 . Our previous studies indicated the importance of blood pressure on increased nocturnal urine production in nocturic older adults with NP, 11–13 and it has also been well documented that hemodynamic changes that occur with aging likely accompany disturbed patterns of diuresis and urinary solutes excretion profiles 14–17 . Thus, etiological factors for nocturia or NP may arise from similar grounds involved in the hemodynamic changes associated with aging.…”