Could Evening Dietary Protein Intake Play a Role in Nocturnal Polyuria?

Alwis, Upeksha Sewwandi; Delanghe, Joris; Dossche, Lien; Walle, Johan Vande; Camp, John Van; Monaghan, Thomas F.; Roggeman, Saskia; Everaert, Karel

doi:10.3390/jcm9082532

Cited by 8 publications

(8 citation statements)

References 34 publications

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“…Accordingly, defining which patients are most appropriately treated with and most likely to respond to fluid restriction for nocturia in a real-world clinical setting remains a pressing research need. Several other conservative interventions are currently supported by varying levels of evidence, but confer minimal risk and warrant consideration in appropriate patients, including dietary sodium restriction, 91,92 reduction in evening protein intake, 93,94 weight loss and regular exercise, 77,95,96 and afternoon compression stockings. 97…”

Section: Actionsmentioning

confidence: 99%

Sleep Disorders, Comorbidities, Actions, Lower Urinary Tract Dysfunction, and Medications (“Sleep C.A.L.M.”) in the evaluation and management of nocturia: A simple approach to a complex diagnosis

Monaghan

Weiss

Wein

et al. 2023

Neurourology and Urodynamics

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Introduction Nocturia arises from a fundamental mismatch between nocturnal urine production, storage capacity, and sleep architecture, which may be driven by abnormalities of the genitourinary tract, but also by sleep disorders, medical diseases, patient actions/lifestyle factors, or medications. This article introduces a novel system for organizing the complex differential diagnosis for nocturia, as proposed by an international collective of practicing urologists, physician specialists, and sleep experts: “Sleep CALM”—Sleep Disorders, Comorbidities, Actions, Lower Urinary Tract Dysfunction, and Medications. Methods Narrative review of current evidence regarding the relevance of each “Sleep CALM” factor to nocturia pathogenesis, evaluation, and management. Results Nocturia and sleep disorders are highly intertwined and often bidirectional, such that nocturnal awakenings for reasons other than a sensation of bladder fullness should not be used as grounds for exclusion from nocturia treatment, but rather leveraged to broaden therapeutic options for nocturia. Nocturia is an important potential harbinger of several serious medical conditions beyond the genitourinary tract. Urologists should have a low threshold for primary care and medical specialty referral for medical optimization, which carries the potential to significantly improve nocturnal voiding frequency in addition to overall health status. Adverse patient actions/lifestyle factors, lower urinary tract dysfunction, and medication use commonly coexist with disordered sleep and comorbid medical conditions, and may be the primary mediators of nocturia severity and treatment response, or further exacerbate nocturia severity and complicate treatment. Conclusion “Sleep CALM” provides a memorable and clinically relevant means by which to structure the initial patient history, physical exam, and clinical testing in accordance with current best‐practice guidelines for nocturia. Although not intended as an all‐encompassing diagnostic tool, the “Sleep CALM” schema may also be useful in guiding individualized ancillary testing, identifying the need for specialty referral and multidisciplinary care, and uncovering first‐line treatment targets.

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Section: Actionsmentioning

confidence: 99%

Sleep Disorders, Comorbidities, Actions, Lower Urinary Tract Dysfunction, and Medications (“Sleep C.A.L.M.”) in the evaluation and management of nocturia: A simple approach to a complex diagnosis

Monaghan

Weiss

Wein

et al. 2023

Neurourology and Urodynamics

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“…Patients with NP demonstrate higher nighttime excretion of urea, indicating that reduction of protein intake in the evening may be beneficial. 36 Other dietary interventions including reduction of alcohol, caffeine, and carbonated beverages may improve symptoms in some patients; however, the data is limited. 37 Limiting caffeine intake in particular should be recommended, as caffeine has specifically been shown to be associated with nocturia.…”

Section: Behavioral and Lifestyle Contributors To Nocturiamentioning

confidence: 99%

Canadian Urological Association best practice report: Diagnosis and management of nocturia

Nguyen

Randhawa

Nadeau

et al. 2022

CUAJ

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relevant articles were also reviewed to identify any other relevant important studies. Quality of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. While there overall was a lack of high-quality evidence to inform aspects of this review, the strength of recommendations was supported by clinical principles, fundamental pathophysiology, and consensus expert opinion. BackgroundThe International Continence Society (ICS) defines nocturia as waking one or more times to void during the hours of sleep, with each void preceded and followed by sleep. 1 Although voiding even once at night is considered nocturia, some literature has shown that fewer than two voids per night does not result in significant patient bother. 2 However, the degree of bother experienced by individual patients will vary according to factors beyond just the number of voids per night. Nocturia is associated with impaired quality of life, 3 and even mortality. 4 This association of nocturia with mortality has been reported to be independent of bother, and should be noted even if patients are not bothered. 5 Patients therefore may benefit from assessment for nocturia even if they don't independently report nocturia, as bother is often what motivates patients to raise nocturia as an issue with their care providers.Depending on the patient population and definition of nocturia used, prevalence varies significantly. [6][7][8] From a Canadian survey of 1000 adults, prevalence, using the ICS definition of one or more episodes per night, was estimated to be 36.4% in all adults and 49.5% in adults over age 65. When defined as two or more episodes per night, prevalence was 9.1% in all adults and 23.8% in adults over the age of 65. 9 Nocturia by any definition increases with age, particularly in men (see Figure 1). 6,7,9 Normal renal function allows for a circadian production of urine, with concentration of urine at night. This function is age-dependent, typically established by age 3 to 5, and leads to decreased nocturnal urine volume. Arginine vasopressin (AVP, or antidiuretic hormone [ADH]) is released from the posterior pituitary and serves as the primary hormone regulating renal water excretion. Factors such as high serum osmolality, hypovolemia and angiotensin II stimulate AVP, leading to water reabsorption, whereas factors such as atrial natriuretic peptide (ANP/ANH), prostaglandin E2 (PGE2) and hypercalcemia inhibit AVP, leading to diuresis. 10 With aging, however, the circadian rhythm of release of these hormones is blunted, which can increase nocturnal urine production.Normal bladder function requires adequate bladder storage and emptying abilities. This requires coordination of multiple components, including the central and peripheral nervous systems, detrusor smooth muscle function, and urethral and pelvic floor function. In addition, the bladder urothelium seems to have a role in regulating urinary function and possibly contributing to AVP-mediated water homeostasis. 10 Important co...

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“…In the clinical setting, there exists significant investigative interest in phenotyping the population of patients most likely to respond to antidiuretic replacement therapy, including our own work on differential trajectories of intra-nocturnal urine production between distinct subsets of patients with nocturnal polyuria. [72][73][74][75][76][77][78] While desmopressin is the only antidiuretic peptide available to treat nocturia and other conditions characterized by AVP deficiency, several alternative small-molecule AVP2R agonists are in various stages of development. A phase II trial of ASP7035 for nocturnal polyuria is listed in the European Clinical Trials Database as ongoing at some study sites (EudraCT2013-003701-25).…”

Section: Current Trends In Antidiuretic Replacement Therapymentioning

confidence: 99%

Section: Antidiuretic Replacement Therapymentioning

confidence: 99%

Pharmacologic management of nocturnal polyuria: a contemporary assessment of efficacy, safety, and progress toward individualized treatment

Monaghan

Weiss

Everaert

et al. 2021

Therapeutic Advances in Urology

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This narrative review synthesizes current evidence on the medical management of nocturnal polyuria, including antidiuretic replacement therapy as well as other emerging modalities, with particular emphasis on areas of active investigation and future research directions. Relative to earlier formulations, the pharmacological profiles of novel desmopressin acetate nasal spray and orally disintegrating tablet formulations appear favorable in optimizing the balance between efficacy and safety. Additionally, several highly selective small-molecule arginine vasopressin 2 receptor agonists are under active development, while appropriately timed short-acting diuretics, pharmacotherapy for hypertension, nonsteroidal anti-inflammatory drugs, and sex hormone replacement therapy are also a focal point of extensive ongoing nocturnal polyuria research. Emerging laboratory technologies now make feasible a sub-stratification of nocturnal polyuria patients into substrate-based phenotypes for individualized treatment. An increasingly refined understanding of the pathogenesis of nocturnal polyuria, and arginine vasopressin dysregulation in particular, has also introduced new opportunities for point-of-care testing in patients with nocturnal polyuria.

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Could Evening Dietary Protein Intake Play a Role in Nocturnal Polyuria?

Cited by 8 publications

References 34 publications

Sleep Disorders, Comorbidities, Actions, Lower Urinary Tract Dysfunction, and Medications (“Sleep C.A.L.M.”) in the evaluation and management of nocturia: A simple approach to a complex diagnosis

Sleep Disorders, Comorbidities, Actions, Lower Urinary Tract Dysfunction, and Medications (“Sleep C.A.L.M.”) in the evaluation and management of nocturia: A simple approach to a complex diagnosis

Canadian Urological Association best practice report: Diagnosis and management of nocturia

Pharmacologic management of nocturnal polyuria: a contemporary assessment of efficacy, safety, and progress toward individualized treatment

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