Water-loss (intracellular) dehydration assessed using urinary tests: how well do they work? Diagnostic accuracy in older people

Hooper, Lee; Bunn, Diane; Abdelhamid, Asmaa; Gillings, Rachel; Jennings, Amy; Maas, Katie; Millar, Sophie A.; Twomlow, Elizabeth; Hunter, Paul R.; Shepstone, Lee; Potter, John F.; Fairweather‐Tait, Susan J.

doi:10.3945/ajcn.115.119925

Cited by 61 publications

(57 citation statements)

References 61 publications

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“…The aim of this study was therefore to determine hydration marker diagnostic accuracy to identify mild intracellular and extracellular dehydration. Based on previous research examining hydration markers after moderate and severe dehydration (Cheuvront et al, 2012;Fortes et al, 2011;Oliver et al, 2008;Shirreffs et al, 2004), we hypothesized that urine, thirst, dry mouth, saliva and HRV markers would identify both types of mild dehydration with adequate diagnostic accuracy (ROC-AUC ≥0.7; Hooper et al 2016). Based on this research we also hypothesized that plasma osmolality and tear osmolarity would identify mild intracellular dehydration, but not mild extracellular dehydration;…”

Section: Introductionmentioning

confidence: 99%

Hydration Marker Diagnostic Accuracy to Identify Mild Intracellular and Extracellular Dehydration

Owen¹,

Fortes²,

Rahman

et al. 2019

International Journal of Sport Nutrition and Exercise Metabolism

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Identifying mild dehydration (≤2% of body mass) is important to prevent the negative effects of more severe dehydration on human health and performance. It is unknown whether a single hydration marker can identify both mild intracellular dehydration (ID) and extracellular dehydration (ED) with adequate diagnostic accuracy (≥0.7 receiver-operating characteristic–area under the curve [ROC-AUC]). Thus, in 15 young healthy men, the authors determined the diagnostic accuracy of 15 hydration markers after three randomized 48-hr trials; euhydration (water 36 ml·kg−1·day−1), ID caused by exercise and 48 hr of fluid restriction (water 2 ml·kg−1·day−1), and ED caused by a 4-hr diuretic-induced diuresis begun at 44 hr (Furosemide 0.65 mg/kg). Body mass was maintained on euhydration, and dehydration was mild on ID and ED (1.9% [0.5%] and 2.0% [0.3%] of body mass, respectively). Urine color, urine specific gravity, plasma osmolality, saliva flow rate, saliva osmolality, heart rate variability, and dry mouth identified ID (ROC-AUC; range 0.70–0.99), and postural heart rate change identified ED (ROC-AUC 0.82). Thirst 0–9 scale (ROC-AUC 0.97 and 0.78 for ID and ED) and urine osmolality (ROC-AUC 0.99 and 0.81 for ID and ED) identified both dehydration types. However, only the thirst 0–9 scale had a common dehydration threshold (≥4; sensitivity and specificity of 100%; 87% and 71%, 87% for ID and ED). In conclusion, using a common dehydration threshold ≥4, the thirst 0–9 scale identified mild intracellular and ED with adequate diagnostic accuracy. In young healthy adults’, thirst 0–9 scale is a valid and practical dehydration screening tool.

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Section: Introductionmentioning

confidence: 99%

Hydration Marker Diagnostic Accuracy to Identify Mild Intracellular and Extracellular Dehydration

Owen¹,

Fortes²,

Rahman

et al. 2019

International Journal of Sport Nutrition and Exercise Metabolism

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“…An additional limitation is that this is a cross‐sectional study; therefore, causality cannot be ascertained. Lastly, we are aware that urinary osmolality may decrease with older age . We tried to account for the effect of age on urine osmolality, along with renal function changes associated with aging, by using an interaction term for age and osmolality in the multivariable models.…”

Section: Discussionmentioning

confidence: 99%

Urinary incontinence and hydration: A population‐based analysis

Willis-Gray

Markland

2017

Neurourology and Urodynamics

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Aims: To determine if there is an association between urinary incontinence (UI) and an objective measure of hydration status in men and women in a nationwide, population-based sample. Methods: We utilized data from the 2009 to 2010 and 2011 to 2012 National Health and Nutrition Examination Surveys (NHANES), cross sectional surveys of the US noninstitutionalized population. Our primary outcome was moderate/severe UI measured using a validated scale. Our exposure of interest was hydration status. Urine osmolality ≥ 800 mOsm/kg defined dehydration versus adequate hydration (<800 mOsm/kg). We included men and women ≥ 20 years who had both UI and urine osmolality data. Using multivariable models, we controlled for age, race/ethnicity, BMI, chronic kidney disease, the interaction of age with osmolality, and hysterectomy (women only). Results: Among the 11 482 total subjects, 9497 (83%-4882 men and 4615 women) had both UI and urine osmolality data. Compared to women, men were less likely to report UI (5.9% vs 18.9%; P < 0.001) and more likely to be dehydrated (33.4% vs 24.0%; P < 0.001). In bivariate analysis, men and women who were dehydrated had less UI than men with adequate hydration (men: 3.5% vs 7.6%; P < 0.001; women: 16.3% vs 20.0%; P = 0.02); however, dehydration was not associated with UI in men (OR 0.2, 95% CI 0.6-1.0) or in women (OR 0.8, 95% CI 0.4-1.5) in multivariable models. Conclusions: Hydration status as defined by urine osmolality was not associated with moderate to severe urinary incontinence in men or women. K E Y W O R D Shydration status, incontinence, osmolality, urinary | INTRODUCTIONUrinary incontinence (UI) is a prevalent condition that affects both men and women of all age groups and can have a significant impact on quality of life. 1 Treatment of UI includes behavioral modifications, medications, neuromodulation, and surgery. The Fourth International Consultation on Incontinence recommends lifestyle interventions as the initial treatment for both men and women suffering from stress (SUI), urgency (UUI), and mixed urinary incontinence. 2 One behavioral intervention is modification of fluid intake, specifically in those who are Hashim Hashim led the peer-review process as the Associate Editor responsible for the paper.200 |

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“…U col thus appears to be particularly suited for applied self-evaluation outside of a research laboratory. However, inconsistencies in past investigations [19,22,23] as well as differentiation between dehydration and underhydration [4] point towards the need for additional and more specific research into the question of how to validly apply urinary markers to determine if, when, and how an individual has returned to adequate water intake following a period of insufficient intake. Therefore, the following investigation had three purposes: (a) to evaluate changes in hydration biomarkers in response to graded rehydration following 3 days of water restriction (WR), (b) assess within-day variation in urine concentration, and (c) quantify the volume of fluid needed to return to a urinary concentration associated with adequate water intake (i.e., a U col of < 4 [7]) as demonstrated by change in U col .…”

Section: Introductionmentioning

confidence: 99%

Urinary markers of hydration during 3-day water restriction and graded rehydration

et al. 2019

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Purpose This investigation had three purposes: (a) to evaluate changes in hydration biomarkers in response to a graded rehydration intervention (GRHI) following 3 days of water restriction (WR), (b) assess within-day variation in urine concentrations, and (c) quantify the volume of fluid needed to return to euhydration as demonstrated by change in U col . Methods 115 adult males and females were observed during 1 week of habitual fluid intake, 3 days of fluid restriction (1000 mL day −1 ), and a fourth day in which the sample was randomized into five different GRHI groups: no additional water, CON; additional 500 mL, G +0.50 ; additional 1000 mL, G +1.00 ; additional 1500 mL, G +1.50 ; additional 2250 mL, G +2.25 . All urine was collected on 1 day of the baseline week, during the final 2 days of the WR, and during the day of GRHI, and evaluated for urine osmolality, color, and specific gravity. Results Following the GRHI, only G +1.50 and G +2.25 resulted in all urinary values being significantly different from CON. The mean volume of water increase was significantly greater for those whose U col changed from > 4 to < 4 (+ 1435 ± 812 mL) than those whose U col remained ≥ 4 (+ 667 ± 722 mL, p < 0.001). Conclusions An additional 500 mL of water is not sufficient, while approximately 1500 mL of additional water (for a total intake between 2990 and 3515 mL day −1 ) is required to return to a urine color associated with adequate water intake, following 3 days of WR.

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Water-loss (intracellular) dehydration assessed using urinary tests: how well do they work? Diagnostic accuracy in older people

Cited by 61 publications

References 61 publications

Hydration Marker Diagnostic Accuracy to Identify Mild Intracellular and Extracellular Dehydration

Hydration Marker Diagnostic Accuracy to Identify Mild Intracellular and Extracellular Dehydration

Urinary incontinence and hydration: A population‐based analysis

Urinary markers of hydration during 3-day water restriction and graded rehydration

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