Urinary Analysis of Fluid Retention in the General Population: A Cross-Sectional Study

Hahn, Robert G.; Grankvist, Nina; Krizhanovskii, Camilla

doi:10.1371/journal.pone.0164152

Cited by 20 publications

(33 citation statements)

References 25 publications

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“…Here, markedly similar maximum urine levels were obtained for all patients, which might suggest a physiological limit for its excretion. The rise is consistent with previous data suggesting a higher urinary concentration of hyaluronic acid when fluid retention occurs, induced by surgical stress, while no such difference is observed for syndecan-1 [ 7 ]. By contrast, the plasma and urine concentrations of heparan sulfate were fairly similar throughout the study, which suggests that this glycosaminoglycan readily equilibrates between the body fluids.…”

Section: Discussionsupporting

confidence: 92%

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Minimal shedding of the glycocalyx layer during abdominal hysterectomy

et al. 2017

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BackgroundSurgery with and without hypervolaemia may cause shedding (breakdown) of the endothelial glycocalyx layer, but the severity of this problem is unclear.MethodsIn this preliminary report of a larger clinical trial, the plasma and urine concentrations of three biomarkers of glycocalyx shedding (syndecan-1, hyaluronic acid and heparan sulfate) were measured in seven patients before, during, and after open hysterectomy. The fluid therapy consisted of 25 ml/kg (approximately 2 l) of Ringer’s lactate, which was infused over 30 min when the surgery started. The resulting plasma volume expansion at the end of the infusion was estimated from the haemodilution.ResultsThe mean plasma concentration of syndecan-1 was 21.7 ng/ml before surgery and averaged 19.7 ng/ml during and after the surgery. The plasma concentration of hyaluronic acid decreased from 38.0 to 27.7 ng/ml (P < 0.05), while heparan sulfate increased from 3.4 to 5.5 μg/ml (P < 0.05). The urine concentrations of syndecan-1 decreased significantly, while they increased for hyaluronic acid and heparan sulfate. Despite the vigorous fluid load, the urine flow did not exceed 1 ml/min.ConclusionsNo clear evidence was found for shedding of the endothelial glycocalyx layer when 2 l of Ringer’s lactate was infused over 30 min during abdominal hysterectomy. Urine analyses yielded patterns of changes that differed from those in plasma.Trial registration ISRCTN81005631. Registered May 17, 2016.

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Section: Discussionsupporting

confidence: 92%

“…We report the urine flow because previous work suggests that different amounts of shedding products are excreted depending on whether the kidneys concentrate the urine [ 7 ]. Despite the vigorous fluid load, the urine flow was very low during the anaesthesia, which is a typical finding in the perioperative setting [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Minimal shedding of the glycocalyx layer during abdominal hysterectomy

et al. 2017

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“…Overlaps between covariates were expected and occurred. Urine osmolality and creatinine are both measures of renal fluid conservation, but creatinine was applied in the model as they more strongly improved the curve‐fit. Similarly, plasma albumin and the colloid osmotic pressure were correlated (Figure ), but plasma albumin was chosen for use.…”

Section: Discussionmentioning

confidence: 99%

Fluid volume kinetics of 20% albumin

Hahn

Zdolsek

Hasselgren

et al. 2019

Brit J Clinical Pharma

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Aims: A population kinetic model was developed for the body fluid shifts occurring when 20% albumin is given by intravenous infusion. The aim was to study whether its efficacy to expand the plasma volume is impaired after major surgery.Methods: An intravenous infusion of 3 mL/kg 20% albumin over 30 minutes was given to 15 volunteers and to 15 patients on the 1 st day after major open abdominal surgery. Blood samples and urine were collected during 5 hours. Mixed-effect modelling software was used to develop a fluid volume kinetic model, using blood haemoglobin and urine excretion the estimate body fluid shifts, to which individualspecific covariates were added in sequence. Results:The rise in plasma albumin expanded the plasma volume in excess of the infused volume by relocating noncirculating fluid (rate constant k 21 ), but it also increased losses of fluid from the kinetic system (k b ). The balance between k 21 and k b maintained the rise in plasma albumin and plasma volume at a virtual steadystate for almost 2 hours. The rate constant for urinary excretion (k 10 ) was slightly reduced by the preceding surgery, by a marked rise in plasma albumin, and by a high preinfusion urinary concentration of creatinine. The arterial pressure, body weight, and plasma concentrations of C-reactive protein and shedding products of the endothelial glycocalyx layer (syndecan-1, heparan sulfate, and hyaluronic acid) did not serve as statistically significant covariates.Conclusions: There were no clinically relevant differences in the kinetics of 20% albumin between postoperative patients and volunteers.

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“…Urine was further analyzed for osmolality and the concentrations of sodium, potassium, creatinine, and albumin. The Fluid Retention Index, which is a summary measure of four urinary indices of renal water conservation (color, osmolality, urine-specific gravity, creatinine), was calculated as previously described [8].…”

Section: Data Collection and Analysesmentioning

confidence: 99%

Signs of Dehydration after Hip Fracture Surgery: An Observational Descriptive Study

Ekman¹,

Johnson²,

Hahn

2020

Medicina

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Background and Objectives. Dehydration might be an issue after hip fracture surgery, but the optimal tools to identify the dehydrated condition have not been determined. The aim of the present study was to compare the characteristics of elderly postoperative patients who were classified as dehydrated according to the methods used in the clinic. Methods. Thirty-eight patients aged between 65 and 97 (mean, 82) years were studied after being admitted to a geriatric department for rehabilitation after hip fracture surgery. Each patient underwent blood analyses, urine sampling, and clinical examinations. Results. Patients ingested a mean of 1,008 mL (standard deviation, 309 mL) of fluid during their first day at the clinic. Serum osmolality increased significantly with the plasma concentrations of sodium, creatinine, and urea. Seven patients had high serum osmolality (≥300 mosmol/kg) that correlated with the presence of tongue furrows (p < 0.04), poor skin turgor (p < 0.03), and pronounced albuminuria (p < 0.03). Eight patients had concentrated urine (urine-specific gravity ≥ 1.025) that correlated with a low intake of liquid and with a decrease in body weight during the past month of −3.0 kg (25–75 th percentiles, −5.1 to −0.9) versus +0.2 (−1.9 to +2.7) kg (p < 0.04). Conclusions. Renal fluid conservation of water, either in the form of hyperosmolality or concentrated urine, was found in 40% of the patients after hip fracture surgery. Hyperosmolality might not indicate a more severe fluid deficit than is indicated by concentrated urine but suggests an impaired ability to concentrate the urine.

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Urinary Analysis of Fluid Retention in the General Population: A Cross-Sectional Study

Cited by 20 publications

References 25 publications

Minimal shedding of the glycocalyx layer during abdominal hysterectomy

Minimal shedding of the glycocalyx layer during abdominal hysterectomy

Fluid volume kinetics of 20% albumin

Signs of Dehydration after Hip Fracture Surgery: An Observational Descriptive Study

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