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Differential Nocturnal Diuresis Rates Among Patients with and Without Nocturnal Polyuria Syndrome.
Eur Urol Focus. 2020 03 15; 6(2):320-326.EU

Abstract

BACKGROUND

The mechanism of nocturnal polyuria (NP), a leading cause of nocturia, is poorly understood.

OBJECTIVE

To characterize NP in terms of diuresis rate changes before and after the first nocturnal awakening.

DESIGN, SETTING, AND PARTICIPANTS

A frequency-volume chart (FVC) database of 773 entries from 440 veterans treated at a Veterans Affairs urology clinic was analyzed. The first FVCs completed by male patients aged ≥18 years with two or more nocturnal voids were included. Patients were excluded if they were taking diuretics or had sleep apnea, heart failure, edema, kidney disease, or diabetes insipidus. The 130 included individuals were divided into two cohorts: patients with NP and patients below this threshold. Analyses were performed using two different cutoffs for NP: nocturnal urine production (NUP) >90ml/h and nocturnal polyuria index (NPi) >0.33.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

We compared "early nocturnal diuresis rate" (ENDR; first nocturnal voided volume/length of first uninterrupted sleep period), "late nocturnal diuresis rate" (LNDR; remaining nocturnal urine volume/remaining hours of sleep), and diurnal diuresis rate (daytime urine volume/hours awake) in patients with the nocturnal polyuria syndrome (NPS).

RESULTS AND LIMITATIONS

Within groups, there were significant differences between ENDR and LNDR for NPS patients at NUP >90ml/h (152 vs 120ml/h, p=0.02) and NPi >0.33 (120 vs 91ml/h, p=0.02) but not for those without NPS at NUP ≤90ml/h (60 vs 59ml/h, p=0.29) or NPi ≤0.33 (75 vs 75ml/h, p=0.25). Limitations include retrospective design, single institution participation, and small sample size.

CONCLUSIONS

There exists a significant drop-off in nocturnal diuresis rate after the time of first awakening that is unique to patients with NPS. The large volume of urine produced in the early hours of sleep may provide the specific substrate for short-acting antidiuretics approved for use in patients with nocturia owing to NPS.

PATIENT SUMMARY

We analyzed adult males diagnosed with nocturnal polyuria syndrome to determine how their rate of urine production changed throughout the night. Our finding that these individuals produce urine at the highest rate in the early hours of sleep suggests that they may benefit from pharmaceuticals specifically designed to reduce urine production during this period.

Authors+Show Affiliations

Department of Urology, SUNY Downstate Medical Center, Brooklyn, NY, USA. Electronic address: monaghantf@gmail.com.Department of Urology, SUNY Downstate Medical Center, Brooklyn, NY, USA.Department of Urology, SUNY Downstate Medical Center, Brooklyn, NY, USA.Department of Urology, SUNY Downstate Medical Center, Brooklyn, NY, USA.Department of Urology, SUNY Downstate Medical Center, Brooklyn, NY, USA.Department of Urology, SUNY Downstate Medical Center, Brooklyn, NY, USA.Urology Department, Ghent University Hospital, Ghent, Belgium.Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.Urology Department, Ghent University Hospital, Ghent, Belgium.Department of Urology, SUNY Downstate Medical Center, Brooklyn, NY, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30392866

Citation

Monaghan, Thomas F., et al. "Differential Nocturnal Diuresis Rates Among Patients With and Without Nocturnal Polyuria Syndrome." European Urology Focus, vol. 6, no. 2, 2020, pp. 320-326.
Monaghan TF, Suss NR, Epstein MR, et al. Differential Nocturnal Diuresis Rates Among Patients with and Without Nocturnal Polyuria Syndrome. Eur Urol Focus. 2020;6(2):320-326.
Monaghan, T. F., Suss, N. R., Epstein, M. R., Flores, V. X., Wu, Z. D., Michelson, K. P., Hervé, F., Bliwise, D. L., Everaert, K., & Weiss, J. P. (2020). Differential Nocturnal Diuresis Rates Among Patients with and Without Nocturnal Polyuria Syndrome. European Urology Focus, 6(2), 320-326. https://doi.org/10.1016/j.euf.2018.10.015
Monaghan TF, et al. Differential Nocturnal Diuresis Rates Among Patients With and Without Nocturnal Polyuria Syndrome. Eur Urol Focus. 2020 03 15;6(2):320-326. PubMed PMID: 30392866.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Differential Nocturnal Diuresis Rates Among Patients with and Without Nocturnal Polyuria Syndrome. AU - Monaghan,Thomas F, AU - Suss,Nicholas R, AU - Epstein,Matthew R, AU - Flores,Viktor X, AU - Wu,Zhan D, AU - Michelson,Kyle P, AU - Hervé,François, AU - Bliwise,Donald L, AU - Everaert,Karel, AU - Weiss,Jeffrey P, Y1 - 2018/11/02/ PY - 2018/09/26/received PY - 2018/10/12/revised PY - 2018/10/29/accepted PY - 2018/11/6/pubmed PY - 2018/11/6/medline PY - 2018/11/6/entrez KW - Diuresis KW - ENDR KW - LNDR KW - LUTS KW - Nocturia KW - Nocturnal Polyuria KW - Nocturnal Polyuria Syndrome SP - 320 EP - 326 JF - European urology focus JO - Eur Urol Focus VL - 6 IS - 2 N2 - BACKGROUND: The mechanism of nocturnal polyuria (NP), a leading cause of nocturia, is poorly understood. OBJECTIVE: To characterize NP in terms of diuresis rate changes before and after the first nocturnal awakening. DESIGN, SETTING, AND PARTICIPANTS: A frequency-volume chart (FVC) database of 773 entries from 440 veterans treated at a Veterans Affairs urology clinic was analyzed. The first FVCs completed by male patients aged ≥18 years with two or more nocturnal voids were included. Patients were excluded if they were taking diuretics or had sleep apnea, heart failure, edema, kidney disease, or diabetes insipidus. The 130 included individuals were divided into two cohorts: patients with NP and patients below this threshold. Analyses were performed using two different cutoffs for NP: nocturnal urine production (NUP) >90ml/h and nocturnal polyuria index (NPi) >0.33. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: We compared "early nocturnal diuresis rate" (ENDR; first nocturnal voided volume/length of first uninterrupted sleep period), "late nocturnal diuresis rate" (LNDR; remaining nocturnal urine volume/remaining hours of sleep), and diurnal diuresis rate (daytime urine volume/hours awake) in patients with the nocturnal polyuria syndrome (NPS). RESULTS AND LIMITATIONS: Within groups, there were significant differences between ENDR and LNDR for NPS patients at NUP >90ml/h (152 vs 120ml/h, p=0.02) and NPi >0.33 (120 vs 91ml/h, p=0.02) but not for those without NPS at NUP ≤90ml/h (60 vs 59ml/h, p=0.29) or NPi ≤0.33 (75 vs 75ml/h, p=0.25). Limitations include retrospective design, single institution participation, and small sample size. CONCLUSIONS: There exists a significant drop-off in nocturnal diuresis rate after the time of first awakening that is unique to patients with NPS. The large volume of urine produced in the early hours of sleep may provide the specific substrate for short-acting antidiuretics approved for use in patients with nocturia owing to NPS. PATIENT SUMMARY: We analyzed adult males diagnosed with nocturnal polyuria syndrome to determine how their rate of urine production changed throughout the night. Our finding that these individuals produce urine at the highest rate in the early hours of sleep suggests that they may benefit from pharmaceuticals specifically designed to reduce urine production during this period. SN - 2405-4569 UR - https://www.unboundmedicine.com/medline/citation/30392866/Differential_Nocturnal_Diuresis_Rates_Among_Patients_with_and_Without_Nocturnal_Polyuria_Syndrome_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S2405-4569(18)30316-X DB - PRIME DP - Unbound Medicine ER -