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Polynocturia in chronic kidney disease is related to natriuresis rather than to water diuresis.
Nephrol Dial Transplant. 2006 Aug; 21(8):2172-7.ND

Abstract

BACKGROUND

Nocturnal polyuria has been well known in renal insufficiency. Recently, we found that as renal function deteriorated in chronic kidney disease (CKD), natriuresis was enhanced during the night with nocturnal blood pressure elevation. In the present study, we investigated whether nocturnal polyuria in CKD was due to the inability to concentrate urine, as previously proposed, or based on osmotic diuresis mainly by natriuresis.

METHODS

In 27 CKD patients, circadian rhythms of urinary sodium, potassium, urea and osmolar excretion rates (U(Na)V, U(K)V, U(urea)V, U(osm)V) as well as of urinary volume (V) and free-water clearance (C(H(2)O)) were estimated during both daytime (6:00 to 21:00) and nighttime (21:00 to 6:00). Then, the night/day ratios of these parameters were analysed in relation to creatinine clearance (C(cr)) as a marker of glomerular filtration rate.

RESULTS

C(cr) had significantly negative relationships with night/day ratios of V (R = -0.69; P < 0.0001), U(osm)V (R = -0.54; P = 0.004) and U(Na)V (R = -0.63; P = 0.0005), but no correlation with night/day ratios of C(H(2)O) (R = -0.33; P = 0.1), U(K)V (R = -0.29; P = 0.1) or U(urea)V (R = -0.31; P = 0.1). Linear and multiple regression analysis identified nocturnal natriuresis rather than urea excretion as an independent determinant of nocturia.

CONCLUSION

As renal function deteriorated, nocturnal polyuria was seen, being consistent with classical recognition. Furthermore, this increase in nocturnal urine volume seemed related to osmotic diuresis mainly by natriuresis rather than to water diuresis or urea excretion.

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Authors+Show Affiliations

Fukuda M
Department of Internal Medicine and Pathophysiology, Nagoya City University Graduate School of Medical Sciences, Mizuho-ku, Nagoya 467-8601, Japan. momoca@sage.ocn.ne.jp
Motokawa M
No affiliation info available
Miyagi S
No affiliation info available
Sengo K
No affiliation info available
Muramatsu W
No affiliation info available
Kato N
No affiliation info available
Usami T
No affiliation info available
Yoshida A
No affiliation info available
Kimura G
No affiliation info available

MeSH

Blood PressureChronic DiseaseCircadian RhythmCreatinineDisease ProgressionDiuresisFemaleGlomerular Filtration RateHumansKidney DiseasesMaleMiddle AgedNatriuresisNocturiaOsmolar ConcentrationPotassiumProteinuriaUrea

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16627609

Citation

Fukuda, Michio, et al. "Polynocturia in Chronic Kidney Disease Is Related to Natriuresis Rather Than to Water Diuresis." Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, vol. 21, no. 8, 2006, pp. 2172-7.
Fukuda M, Motokawa M, Miyagi S, et al. Polynocturia in chronic kidney disease is related to natriuresis rather than to water diuresis. Nephrol Dial Transplant. 2006;21(8):2172-7.
Fukuda, M., Motokawa, M., Miyagi, S., Sengo, K., Muramatsu, W., Kato, N., Usami, T., Yoshida, A., & Kimura, G. (2006). Polynocturia in chronic kidney disease is related to natriuresis rather than to water diuresis. Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, 21(8), 2172-7.
Fukuda M, et al. Polynocturia in Chronic Kidney Disease Is Related to Natriuresis Rather Than to Water Diuresis. Nephrol Dial Transplant. 2006;21(8):2172-7. PubMed PMID: 16627609.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Polynocturia in chronic kidney disease is related to natriuresis rather than to water diuresis. AU - Fukuda,Michio, AU - Motokawa,Masahiro, AU - Miyagi,Sota, AU - Sengo,Kinya, AU - Muramatsu,Wataru, AU - Kato,Nobuo, AU - Usami,Takeshi, AU - Yoshida,Atsuhiro, AU - Kimura,Genjiro, Y1 - 2006/04/20/ PY - 2006/4/22/pubmed PY - 2007/4/5/medline PY - 2006/4/22/entrez SP - 2172 EP - 7 JF - Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association JO - Nephrol Dial Transplant VL - 21 IS - 8 N2 - BACKGROUND: Nocturnal polyuria has been well known in renal insufficiency. Recently, we found that as renal function deteriorated in chronic kidney disease (CKD), natriuresis was enhanced during the night with nocturnal blood pressure elevation. In the present study, we investigated whether nocturnal polyuria in CKD was due to the inability to concentrate urine, as previously proposed, or based on osmotic diuresis mainly by natriuresis. METHODS: In 27 CKD patients, circadian rhythms of urinary sodium, potassium, urea and osmolar excretion rates (U(Na)V, U(K)V, U(urea)V, U(osm)V) as well as of urinary volume (V) and free-water clearance (C(H(2)O)) were estimated during both daytime (6:00 to 21:00) and nighttime (21:00 to 6:00). Then, the night/day ratios of these parameters were analysed in relation to creatinine clearance (C(cr)) as a marker of glomerular filtration rate. RESULTS: C(cr) had significantly negative relationships with night/day ratios of V (R = -0.69; P < 0.0001), U(osm)V (R = -0.54; P = 0.004) and U(Na)V (R = -0.63; P = 0.0005), but no correlation with night/day ratios of C(H(2)O) (R = -0.33; P = 0.1), U(K)V (R = -0.29; P = 0.1) or U(urea)V (R = -0.31; P = 0.1). Linear and multiple regression analysis identified nocturnal natriuresis rather than urea excretion as an independent determinant of nocturia. CONCLUSION: As renal function deteriorated, nocturnal polyuria was seen, being consistent with classical recognition. Furthermore, this increase in nocturnal urine volume seemed related to osmotic diuresis mainly by natriuresis rather than to water diuresis or urea excretion. SN - 0931-0509 UR - https://www.unboundmedicine.com/medline/citation/16627609/Polynocturia_in_chronic_kidney_disease_is_related_to_natriuresis_rather_than_to_water_diuresis_ L2 - https://academic.oup.com/ndt/article-lookup/doi/10.1093/ndt/gfl165 DB - PRIME DP - Unbound Medicine ER -