Differential Nocturnal Diuresis Rates Among Patients with and Without Nocturnal Polyuria Syndrome

Monaghan, Thomas F.; Suss, Nicholas R.; Epstein, Matthew; Flores, Viktor; Wu, Zhan D.; Michelson, Kyle P.; Hervé, François; Bliwise, Donald L.; Everaert, Karel; Weiss, Jeffrey P.

doi:10.1016/j.euf.2018.10.015

Cited by 8 publications

(16 citation statements)

References 20 publications

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Section: Discussionsupporting

confidence: 90%

“…In this investigation, patients with an early peak nocturnal diuresis rate were more likely to have NPS, which is consistent with our previous study comparing NPS to controls without NP. 10 Although significance was met only in the crude odds ratio using the NP criterion of NUP ≥ 90 mL/hour, odds ratios were similar for both definitions of NP, which persisted after multivariate adjustment. Consistently, a peak diuresis rate during the late nocturnal period was more likely in patients with secondary NP, and patients with individual diagnoses of OSA, CHF, and CKD uniformly demonstrated a greater median nocturnal diuresis rate during the late nocturnal period.…”

Section: Resultsmentioning

confidence: 90%

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Time of peak nocturnal diuresis rate between men with secondary nocturnal polyuria versus nocturnal polyuria syndrome

Monaghan

Epstein

Bliwise

et al. 2020

Neurourology and Urodynamics

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Aim: Compare the circadian trajectory of diuresis between nocturnal polyuria (NP) patients with versus without identifiable contributory comorbidities. Methods: Retrospective analysis of frequency-volume charts from male patients with clinically-significant nocturia (≥2 nocturnal voids) and NP (defined by nocturnal urine production [NUP] ≥90 mL/hour or nocturnal polyuria index [NPi] ≥0.33). Patients with NP and chronic kidney disease, congestive heart failure, and/or undertreated obstructive sleep apnea (OSA) were deemed to have secondary NP. Nocturnal polyuria syndrome (NPS) was defined as NP without edema, loop diuretic use, or the aforementioned conditions. Patients with diabetes insipidus or OSA with appropriate continuous positive airway pressure utilization were excluded. The timing and volumes of nocturnal voids were used to derive "early" and "late" nocturnal diuresis rates (mL/hour of urine produced before and after the first nocturnal awakening, respectively). The likelihood of an early peak nocturnal diuresis rate (ie, early >late nocturnal diuresis rate) was compared between patients with NPS versus secondary NP using both a crude and adjusted odds ratio. Results: The likelihood of an early peak nocturnal diuresis rate in patients with NPS compared with secondary NP was 2.58 (1.05-6.31) at NUP ≥ 90 mL/hour and 1. 96 (0.87-4.42) at NPi ≥ 0.33 on crude analysis, and 2.44 (0.96-6.24) and 1.93 (0.83-4.48) after adjustment, respectively.Conclusions: A peak early nocturnal diuresis rate was significantly more likely in patients with NPS at NUP ≥ 90 mL/hour, with similar odds ratios at NPi ≥ 0.33 and following adjustment. Delineating nocturic patients by NP subgroup may facilitate more individualized management.

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Section: Discussionsupporting

confidence: 90%

Section: Resultsmentioning

confidence: 90%

Time of peak nocturnal diuresis rate between men with secondary nocturnal polyuria versus nocturnal polyuria syndrome

Monaghan

Epstein

Bliwise

et al. 2020

Neurourology and Urodynamics

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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%

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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“…Until recently, it was not understood whether loss of normal circadian oscillations in urine production in patients with NPS resulted in a uniformly high or phasic nocturnal diuresis rate (DR). To this end, changes in DR throughout the night between sleeping hours before and after the first nocturnal awakening to void were studied, 13 based on a voiding diary database of 773 entries from 440 adult men treated at a Veterans Affairs clinic for lower urinary tract symptoms (LUTS). Patients were excluded if they were taking diuretics or had OSA, CHF, edema, CKD, or DI.…”

Section: Nps Prevalence and Characterization Of Nps Based On Diuresis Ratesmentioning

confidence: 99%

Future Considerations in Nocturia and Nocturnal Polyuria

Weiss

Monaghan

Epstein

et al. 2019

Urology

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Differential Nocturnal Diuresis Rates Among Patients with and Without Nocturnal Polyuria Syndrome

Cited by 8 publications

References 20 publications

Time of peak nocturnal diuresis rate between men with secondary nocturnal polyuria versus nocturnal polyuria syndrome

Time of peak nocturnal diuresis rate between men with secondary nocturnal polyuria versus nocturnal polyuria syndrome

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

Future Considerations in Nocturia and Nocturnal Polyuria

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