Atrial Natriuretic Peptide Levels in Geriatric Patients with Nocturia and Nursing Home Residents with Nighttime Incontinence
ABSTRACT To determine if nocturnal polyuria in geriatric patients with nocturia and nocturnal incontinence is associated with elevated plasma atrial natriuretic peptide (ANP) levels.
Four nursing homes and two board and care facilities.
Fifty-four nursing home residents and 26 board and care residents with a mean age of 86.
Daytime (7:00 a.m. to 7:00 p.m.) and nighttime (7:00 p.m. to 7:00 a.m.) urine volumes of incontinent nursing home residents were measured over 3 days and 3 nights by reweighing preweighed adults diapers and toileting inserts emptied by research staff for the board and care group. Blood was drawn in the early morning (5:00 a.m. to 7:00 a.m.) before subjects arose and in the evening after an hour of lying in bed (8:00 p.m. to 11:00 p.m.), and plasma ANP levels were determined by radioimmunoassay.
Forty-nine (61%) of the subjects had nocturnal polyuria as defined by night/total urine volume ratios > or = 50%. There was no significant difference between those with night/total ratios > or = 50% versus < 50% in plasma levels of ANP in the early morning (44.2+/-33.3, median 35.7 pg/mL vs 40.9+/-39.2, median 28.5; P = .36 by Mann Whitney U) or in the evening (43.4+/-28.8, median 36.4 pg/mL vs 49.6+/-53.1, median 34.4; P = .58). Nor was there any significant correlation between night/total urine volume ratio and morning or evening ANP levels (r = .01, P = .96 and r = .23, P = .31, respectively).
In this sample of geriatric patients with nocturia and nursing home residents with nighttime urinary incontinence, ANP levels were elevated, but increased nighttime urine production was not associated with higher levels. Because of the variability in ANP levels, our power to detect such an association was low, and we cannot draw any definitive conclusions. Although high plasma ANP levels are unlikely to be a primary cause of nocturia and nighttime incontinence, they may, when combined with other factors such as low antidiuretic hormone levels, sleep disorders, and low functional bladder capacity, contribute to these symptoms in some geriatric patients.
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ABSTRACT: We assessed the association of renal function with frequent nighttime urination in older adults. We recruited a convenience sample of 48 adults 65 years old and older, and admitted them to a general clinical research center. Of the 48 participants 45 completed a 7-day voiding record, ate a research diet for 4 days and finished a 3-day stay with 3 glomerular filtration rate measurements, including an estimation of serum creatinine using the Cockcroft-Gault formula, a calculation using 24-hour urine volume and a determination by 131iodine iothalamate clearance. Subjects with frequent nighttime voiding, defined as a mean of 2 or more voiding episodes from 11 p.m. to 7 a.m., had slightly lower but statistically similar glomerular filtration rate measurements than those with a mean of less than 2 nighttime voids. The glomerular filtration rate did not correlate with the number of nighttime voids (Pearson correlation coefficient -0.006, p = 0.971). Mean 24-hour urine output was similar in the 2 groups and the correlation of the number of nighttime voids with 24-hour urine output was insignificant (Pearson correlation coefficient -0.06, p = 0.683). A greater number of nighttime voids was associated with producing more urine at night and smaller mean voided volume. As determined by a gold standard glomerular filtration rate measurement, renal function was not associated with the number of nighttime voids in our study population. Total 24-hour urine output was also not associated with the number of nighttime voids. Our findings confirmed the positive association of a greater number of nighttime voids with greater nighttime urine production and lower bladder voided volume.The Journal of Urology 02/2002; 167(1):146-50. DOI:10.1016/S0022-5347(05)65401-8 · 3.75 Impact Factor
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ABSTRACT: To examine polysomnographic correlates of spontaneously occurring nocturnal wetness episodes (NWEs) in incontinent geriatric patients. Cross-sectional, descriptive study. Subjects were 27 long-term nursing home residents known to be incontinent at night who were studied polysomnographically for 1 (n = 22) or 2 (n = 5) nights in their own rooms. None. Traditional polysomnographic measurements were supplemented with a wetness monitor with a relay switch worn inside a diaper. A total of 106 NWEs were recorded, with approximately one third of all originating from sleep (non-rapid eye movement = 31; rapid eye movement = 4). Of the 106 total episodes, 11 (10.4%) began during a sleep-disordered breathing (SDB) event and 43 (40.6%) commenced within 60 seconds of termination of a breathing event. Urine volumes were calculated by weighing the diaper before and after each NWE. Volumes were significantly lower in NWEs originating during SDB events (127.1 mL vs 163.9 mL, t = 2.09, P < .05). These results demonstrate that in a geriatric nursing-home population, many NWEs arise specifically from sleep and do not simply represent nocturnal voids made in response to difficulties in ambulation and arising from bed. A relatively large proportion of NWEs were related to SDB. Although SDB may be associated with nocturnal diuresis, the lower urine volumes associated with NWEs co-occurring with SDB raise the possibility that mechanical factors, such as downward displacement of the diaphragm exerting pressure on the detrusor, may contribute to urine leakage during sleep in such patients.Sleep 03/2004; 27(1):153-7. · 5.06 Impact Factor
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ABSTRACT: Nocturia is common in the elderly population and, aside from being a nuisance, it is associated with morbidity and mortality. Nocturia results from the complex interactions of several factors: changes in the urinary system and renal function with aging, the effects of sleep on renal function, changes in sleeping patterns associated with aging, and the presence of concurrent diseases and medications. Nocturia in the elderly can be caused by many conditions; a common cause is the syndrome of nocturnal polyuria. Although the pathophysiology of nocturnal polyuria remains obscure, some investigators believe that low night-time levels of antidiuretic hormone are involved. Proper management of nocturia requires identification of the specific underlying causes. This Review provides an overview of the mechanisms, evaluation and treatment of nocturia for the practicing nephrologist.Nature Clinical Practice Nephrology 07/2008; 4(8):426-35. DOI:10.1038/ncpneph0856 · 6.08 Impact Factor