Overall, it has been established that nocturnal polyuria is a component of nocturia ( 5). The normal range of nocturnal urine volume appears to be wide in large populations with a narrower age range. Nocturnal polyuria refers to the excessive excretion of urine at night. In healthy adults, nights are associated with a significant decrease in urine production and excretion of water and soluble substances ( 4). In patients undergoing renal transplantation, urine volume increases during the night ( 3). This treatment is more cost-effective than dialysis ( 2), and its prevalence is increasing among people. Renal transplant has been an effective treatment for end-stage renal disease, resulting in the improved quality of life and survival of patients ( 1). Nocturia Nocturnal Polyuria Nocturnal Blood Pressure Dipping Urine Osmolarity Urine Sodium Creatinine Clearance 1. All rights reserved.Since nondipping blood pressure is associated with more tissue damage and deterioration of renal transplant outcomes, control of hypertension and changes in the time of antihypertensive drug administration (for improving blood pressure dipping at night) may prevent the adverse effects of nondipping blood pressure. A group of experts was able to develop practical approaches for assessing and treating this condition.Ĭhronic kidney disease Lower urinary tract symptoms Nocturia Nominal group technique Systematic review.Ĭopyright © 2021 European Association of Urology. We looked at published research and found some useful information about the underlying mechanisms. People with kidney disease can suffer severe sleep disturbance because of a need to pass urine overnight. The aim of assessment is to identify mechanisms and instigate therapy, but the latter may be more applicable to reducing wider morbidity associated with CKD than nocturia itself. Referral to specialist nephrology services should follow local guidelines.ĬKD should be considered when evaluating patients with nocturia. Treatment options include optimising blood pressure control, dietary adjustment to reduce salt intake, fluid advice, and a medication review. Renal ultrasound should follow local CKD guidelines. NGT assessment recommendations for nocturia (at least two voids per night) in patients with CKD or at risk of CKD being assessed in a non-nephrology setting are: history (thirst, fluid intake), medication review (diuretics, lithium, calcium channel antagonists, nonsteroidal anti-inflammatory medications), examination (oedematous state, blood pressure), urinalysis (haematuria and albumin/creatinine ratio), blood tests (blood urea, serum creatinine and electrolytes, estimated glomerular filtration rate), and a bladder diary. Several plausible mechanisms contribute to nocturnal or 24-h polyuria in CKD, but there is little evidence on interventions to improve nocturia. Consensus was achieved among an expert panel with public involvement using the nominal group technique (NGT). Seven studies met the inclusion criteria and two were identified through other sources. A total of 4011 titles and abstracts were screened, and 108 studies underwent full-text screening. To conduct a systematic review (SR) of nocturia in CKD and achieve expert consensus for management in primary care and in specialist clinics outside nephrology.įour databases were searched from January 2000 to April 2020. Evidence-based recommendations can facilitate management outside nephrology clinics. Nocturia can arise early in chronic kidney disease (CKD). Reduced renal function impairs salt and water homeostasis, which can drive nocturnal or 24-h polyuria. 8 Nuffield Department of Medicine, University of Oxford, Oxford, UK Oxford Kidney Unit, Churchill Hospital, Oxford, UK.7 Nephrology Department, Southmead Hospital, North Bristol NHS Trust, Bristol, UK.6 Tyntesfield Medical Group, Bristol, UK.Electronic address: 5 Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK Older Person's Unit, Royal United Hospital NHS Foundation Trust Bath, Combe Park, Bath, UK. 4 Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.3 Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.2 Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK School of Health and Social Wellbeing, University of the West of England, Bristol, UK.1 Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK.
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