Low‐dose desmopressin combined with serum sodium monitoring can prevent clinically significant hyponatraemia in patients treated for nocturia

Juul, Kristian Vinter; Malmberg, Anders; Meulen, Egbert van der; Walle, Johan Vande; Nørgaard, Jens Peter

doi:10.1111/bju.13718

Cited by 35 publications

(38 citation statements)

References 22 publications

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“…Patients with nocturia have to face many hurdles before being diagnosed properly and treated with desmopressin, instead of OAB/BPO medication . Potential reasons for this, besides side effects, are the limited knowledge of clinicians regarding the drug and how to use it, and anxiety about safety, regardless of the evidence that with the available low‐dose formulations, hyponatremia is extremely rare, even in older patients . There is a clear need for a summary of the available information and a simple algorithm on how desmopressin should be used in adults with nocturia.…”

Section: Introductionmentioning

confidence: 99%

International Continence Society consensus on the diagnosis and treatment of nocturia

Everaert

Hervé

Bosch

et al. 2019

Neurourology and Urodynamics

109

104

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Introduction Patients with nocturia have to face many hurdles before being diagnosed and treated properly. The aim of this paper is to: summarize the nocturia patient pathway, explore how nocturia is diagnosed and treated in the real world and use the Delphi method to develop a practical algorithm with a focus on what steps need to be taken before prescribing desmopressin. Methods Evidence comes from existing guidelines (Google, PubMed), International Consultation on Incontinence‐Research Society (ICI‐RS) 2017, prescribing information and a Delphi panel (3 rounds). The International Continence Society initiated this study, the authors represent the ICI‐RS, European Association of Urology, and Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU). Results Diagnostic packages: consensus on, history taking for all causalities, intake diary (fluid, food) and bladder diary, not for its duration. Pelvic (women) or rectal (men) examination, prostate‐specific antigen, serum sodium check (SSC), renal function, endocrine screening: when judged necessary. Timing or empty stomach when SSC is not important. Therapeutic packages: the safe candidates for desmopressin can be phenotyped as no polydipsia, heart/kidney failure, severe leg edema or obstructive sleep apnea syndrome. Lifestyle interventions may be useful. Initiating desmopressin: risk management consensus on three clinical pictures. Follow‐up of desmopressin therapy: there was consensus on SSC day 3 to 7, and at 1 month. Stop therapy if SSC is <130 mmol/L regardless of symptoms. Stop if SSC is 130 to 135 mmol/L with symptoms of hyponatremia. Conclusion A summary of the nocturia patient pathway across different medical specialists is useful in the visualization and phenotyping of patients for diagnosis and therapy. By summarizing basic knowledge of desmopressin, we aim to ease its initiation and shorten the patient journey for nocturia.

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Section: Introductionmentioning

confidence: 99%

International Continence Society consensus on the diagnosis and treatment of nocturia

Everaert

Hervé

Bosch

et al. 2019

Neurourology and Urodynamics

109

104

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“…38,40 It is important to remain aware that hyponatremia is a notable side effect of desmopressin therapy, as well, particularly in patients 65 years or older. 46 The risk of hyponatremia is 8% in patients over 65 compared with 1% in younger patients. 47 Individual countries have licensed varying preparations of desmopressin listed herein.…”

Section: Choi Ce Of Tre Atmentmentioning

confidence: 99%

Current guidelines and treatment paradigms for nocturnal polyuria: A “NEW” disease state forUSphysicians, patients and payers

Flores

Weiss

2019

Int J Clin Pract

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Nocturia is one of the most bothersome symptoms encountered in urology, and its prevalence rises with age. Causes include both urological and non‐urological aetiologies, often in combination. The effects of nocturia on a patient's quality of life can be detrimental. The initial approach to managing this condition includes appropriately classifying nocturia based on the results of a 24‐hour bladder diary. Broadly, the categories under which nocturia can be classified include: low nocturnal or global bladder capacity, nocturnal polyuria, global polyuria and mixed.Based on the type of nocturia and possible underlying causes, clinicians can appropriately discuss with patients the treatment plans that may include a combination of behavioural, pharmacologic, and invasive therapy. The available literature on the management of nocturia was reviewed. Findings were incorporated into a practice‐based approach for its workup and treatment.

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“…This phenomenon is explained by larger expression of V2 receptors for vasopressin [ 23 ]. For this reason, following the results of numerous clinical studies evaluating therapeutic and adverse effects (in this case especially the risk of hyponatremia), it was found that the recommended daily therapeutic dose for women was 25 µg and for men 50 µg desmopressin lyophilisate, administered sublingually 1 hour before bedtime [ 24 , 25 , 26 ]. In the above studies, subjects receiving desmopressin reported, in comparison to the placebo patients, a significant improvement in the number of nocturia episodes, and also the secondary endpoints, which included an assessment of the overall quality of life and sleep.…”

Section: Desmopressin In the Treatment Of Nocturnal Polyuriamentioning

confidence: 99%

Diagnostic and therapeutic recommendations for patients with nocturia

Miotła

Dobruch

Lipiński

et al. 2017

CEJU

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IntroductionNocturia is defined as the urge to urinate at night when the micturition was directly preceded and followed by sleep. Due to its negative impact on the quality of life of patients, an effective treatment for this disease has become a significant therapeutic challenge. The aim of this article was to explain the main risk factors for the occurrence of nocturia and to present diagnostic and therapeutic schemes in the case of nocturnal polyuria (idiopathic night time polyuria).Material and methodsA review of the literature was carried out and the available guidelines of international science societies, which provided the basis for the above recommendations, were analyzed.ResultsDetailed medical history should include information concerning: lower urinary tract symptoms (including nocturia), underlying illnesses, urogenital disorders, previous surgeries and medications administered. Keeping a bladder diary is recommended. The physical examination, depending on the patient's gender, should include gynecological examination with pelvic organ prolapse assessment or prostate evaluation. In laboratory tests, a urinalysis may be used, in particular cases a cytological analysis of urine sediment may be carried out. In addition, a possible ultrasound and/or cystoscopy may be conducted. Nocturia therapy should begin with modifying dietary habits, including compliance with the fluid regimen, avoiding alcohol, coffee and tea. Moderate physical exercise is also recommended. The pharmacological treatment of nocturia caused by nocturnal polyuria is based on the use of desmopressin at a daily single dose of 25 µg for women and 50 µg for men. The use of desmopressin allows for the reduction in the number of nocturia episodes, as well as improves the overall quality of life and sleep. Treatment with desmopressin can also be considered as a form of therapy added in people with an overactive bladder or benign prostatic hyperplasia, in which nocturia is a significant clinical problem.ConclusionsDesmopressin is an effective and safe first-line treatment option in pharmacological therapy of nocturia caused by nocturnal polyuria.

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Low‐dose desmopressin combined with serum sodium monitoring can prevent clinically significant hyponatraemia in patients treated for nocturia

Cited by 35 publications

References 22 publications

International Continence Society consensus on the diagnosis and treatment of nocturia

International Continence Society consensus on the diagnosis and treatment of nocturia

Current guidelines and treatment paradigms for nocturnal polyuria: A “NEW” disease state forUSphysicians, patients and payers

Diagnostic and therapeutic recommendations for patients with nocturia

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