Nocturia: a marker of furosemide treatment response? An exploratory study

Neurourology and Urodynamics

Lee

et al. 2020

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Aims: Nocturia has been increasingly recognized as a potential manifestation of cardiovascular disease. However, the relationship between nocturia and electrocardiographic (ECG) abnormalities has not been studied. This study aims to characterize the diagnostic utility of nocturia in identifying left ventricular hypertrophy (LVH), left atrial enlargement (LAE), and prolonged QTc on ECG. Methods: Retrospective analysis of nocturnal voiding frequency and contemporaneous ECG data from consecutive patients evaluated at a university-based outpatient cardiology clinic. Three sets of three incremental binary multiple logistic regression models controlling for (1) age, (2) sex and race, and (3) body mass index, hypertension, diabetes mellitus, and diuretic utilization were performed to determine whether nocturia was predictive of LVH, LAE, and prolonged QTc. Results: Included patients (n = 143, 77.6% nocturia) were predominantly African-American (89.5%), female (74.1%), and obese (61.5%), of whom 44.1%, 41.3%, and 27.3% had LVH, LAE, and prolonged QTc, respectively. Older age, African-American race, obesity, hypertension, diuretic use, LVH, and LAE were significantly associated with nocturia on univariate analysis. No significant differences were observed in the strength of associations between nocturia and LVH, LAE, or QTc prolongation based on age. Nocturia independently predicted LVH in Models I-III (odds ratios [ORs], 2.99-3.20; relative risks [RRs], 1.18 for all, p ≤ .046) and LAE in Models I-III (ORs, 4.24-4.72; RRs, 1.21 for all, p ≤ .015). No significant associations were observed between nocturia and prolonged QTc. Conclusions: Nocturia may be a risk marker for underlying structural cardiac abnormalities.

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Nocturia and electrocardiographic abnormalities among patients at an inner‐city cardiology clinic

Mekki

Neurourology and Urodynamics

Lee

et al. 2020

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“…69 Similarly, in an outpatient cardiology clinic, improvement in nocturia severity has also been identified as a potential early marker of response to diuretic therapy in the treatment of heart failure. 70 As it relates to clinical practice in the initial evaluation of nocturia, investigation of potential contributory comorbidities requires comprehensive medical history including a detailed review of systems, physical exam not limited to the genitourinary tract, and low threshold for primary care referral for further disease optimization, with potential subsequent medical specialty referral if the appropriate indications are met. Notably, current evidence favoring medical disease optimization as a primary first-line intervention for nocturia is limited by a paucity of randomized control trial evidence, and the fact that nocturia is most often reported as a secondary or post hoc outcome in relevant literature.…”

Section: Comorbiditiesmentioning

confidence: 99%

“…For example, in one sample of patients hospitalized for decompensated heart failure, severe nocturia before admission was associated with significantly greater baseline edema severity and serum brain natriuretic peptide concentration, as well as greater absolute improvement in these parameters following standard volume management with diuretics 69 . Similarly, in an outpatient cardiology clinic, improvement in nocturia severity has also been identified as a potential early marker of response to diuretic therapy in the treatment of heart failure 70 …”

Section: Introductionmentioning

confidence: 99%

Sleep Disorders, Comorbidities, Actions, Lower Urinary Tract Dysfunction, and Medications (“Sleep C.A.L.M.”) in the evaluation and management of nocturia: A simple approach to a complex diagnosis

Neurourology and Urodynamics

Weiss

Wein

et al. 2023

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Introduction Nocturia arises from a fundamental mismatch between nocturnal urine production, storage capacity, and sleep architecture, which may be driven by abnormalities of the genitourinary tract, but also by sleep disorders, medical diseases, patient actions/lifestyle factors, or medications. This article introduces a novel system for organizing the complex differential diagnosis for nocturia, as proposed by an international collective of practicing urologists, physician specialists, and sleep experts: “Sleep CALM”—Sleep Disorders, Comorbidities, Actions, Lower Urinary Tract Dysfunction, and Medications. Methods Narrative review of current evidence regarding the relevance of each “Sleep CALM” factor to nocturia pathogenesis, evaluation, and management. Results Nocturia and sleep disorders are highly intertwined and often bidirectional, such that nocturnal awakenings for reasons other than a sensation of bladder fullness should not be used as grounds for exclusion from nocturia treatment, but rather leveraged to broaden therapeutic options for nocturia. Nocturia is an important potential harbinger of several serious medical conditions beyond the genitourinary tract. Urologists should have a low threshold for primary care and medical specialty referral for medical optimization, which carries the potential to significantly improve nocturnal voiding frequency in addition to overall health status. Adverse patient actions/lifestyle factors, lower urinary tract dysfunction, and medication use commonly coexist with disordered sleep and comorbid medical conditions, and may be the primary mediators of nocturia severity and treatment response, or further exacerbate nocturia severity and complicate treatment. Conclusion “Sleep CALM” provides a memorable and clinically relevant means by which to structure the initial patient history, physical exam, and clinical testing in accordance with current best‐practice guidelines for nocturia. Although not intended as an all‐encompassing diagnostic tool, the “Sleep CALM” schema may also be useful in guiding individualized ancillary testing, identifying the need for specialty referral and multidisciplinary care, and uncovering first‐line treatment targets.

“…Because diuretics are a core tenet in the management of congestive heart failure and other volume overload states, and daytime third-space fluid sequestration, in and of itself, is an important pathophysiologic mechanism of nocturnal polyuria in some patients, 100 the population-level association between nocturia and diuretics is likely explained, in large part, by the status of diuretics as a marker of volume overload states. 101,102 In contrast, among otherwise healthy adults, administration of short-acting diuretics in the afternoon (i.e., more than 4-6 h prior to bedtime) is thought to improve nocturia by restoring the circadian rhythm of sodium homeostasis. 103 In a double-blind randomized placebo-controlled crossover study, adults regularly experiencing ⩾2 nocturnal voids in a general practice setting were administered 2 weeks of bumetanide 1 mg and of placebo, taken 4−6 h prior to bedtime.…”

Section: Additional Pharmacotherapies For Nocturnal Polyuriamentioning

confidence: 99%

Pharmacologic management of nocturnal polyuria: a contemporary assessment of efficacy, safety, and progress toward individualized treatment

Therapeutic Advances in Urology

Weiss

Everaert

et al. 2021

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This narrative review synthesizes current evidence on the medical management of nocturnal polyuria, including antidiuretic replacement therapy as well as other emerging modalities, with particular emphasis on areas of active investigation and future research directions. Relative to earlier formulations, the pharmacological profiles of novel desmopressin acetate nasal spray and orally disintegrating tablet formulations appear favorable in optimizing the balance between efficacy and safety. Additionally, several highly selective small-molecule arginine vasopressin 2 receptor agonists are under active development, while appropriately timed short-acting diuretics, pharmacotherapy for hypertension, nonsteroidal anti-inflammatory drugs, and sex hormone replacement therapy are also a focal point of extensive ongoing nocturnal polyuria research. Emerging laboratory technologies now make feasible a sub-stratification of nocturnal polyuria patients into substrate-based phenotypes for individualized treatment. An increasingly refined understanding of the pathogenesis of nocturnal polyuria, and arginine vasopressin dysregulation in particular, has also introduced new opportunities for point-of-care testing in patients with nocturnal polyuria.