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- Rembratt, Åsa, et al.
(författare)
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Desmopressin treatment in nocturia; an analysis of risk factors for hyponatremia.
- 2006
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Ingår i: Neurourology and Urodynamics. - : Wiley. - 0733-2467 .- 1520-6777. ; 25:2, s. 105-109
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Tidskriftsartikel (refereegranskat)abstract
- Aims: To explore the incidence, severity, time course, and risk factors of clinically significant hyponatremia in desmopressin treatment for nocturia. Methods: Data from three multi-center phase 111 trials were pooled. Hyponatremia was categorised as borderline (134-130 mmol/L) or significant (<130 mmol/L). Risk factors were explored with logistic regression and subgroup analysis performed to explore threshold values for contra-indication. Results: In total 632 patients (344 men, 288 women) were analyzed. During dose-titrition, serum sodium concentration below normal range was recorded in 95 patients (15%) and 31 patients (4.9%) experienced significant hyponatremia. The risk increased with age, lower serum sodium concentration at baseline, higher basal 24-hr urine volume per bodyweight and weight gain at time of minimum serum sodium concentration. Age was the best single predictor. Elderly patients (>= 65 years of age) with a baseline serum sodium concentration below normal range were at high risk (75%). Limiting treatment in elderly with normal basal serum sodium concentration to those below 79 years and with a 24-hr urine output below 28 ml/kg would reduce the risk from 8.1% to 3.0% at the cost of 34% fulfilling the contra-indication. Conclusions: The majority of nocturia patients tolerate desmopressin treatment without clinically significant hyponatremia. However, the risk increases with increasing age and decreasing baseline serum sodium concentration. Treatment of nocturia in elderly patients with desmopressin should only be undertaken together with careful monitoring of the scrum sodium concentration. Patients with a baseline serum sodium concentration below normal range should not be treated.
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- Rembratt, Åsa
(författare)
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Nocturia in the elderly. Aspects on epidemiology, pathogenesis, and antidiuretic treatment.
- 2003
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Analysis of nocturia questionnaires mailed to all persons aged 65 years or more in Tierp, a Swedish rural community, showed that the number of nocturnal voids was highly correlated with urge and incontinence. No correlation between nocturia and a known and treated hypertension, angina, congestive heart failure or diabetes mellitus was detected. Frequency-volume charts from elderly subjects with two or more voids per night (nocturics) were compared with those reporting <1 void/night (non-nocturics). Nocturics had a higher nocturnal urine production and lower volume per void than non-nocturics. The differences between nocturics and non-nocturics in urine production and largest voided volume did not follow the same pattern in men and women. Considerable overlap was found in all studied voiding parameters and nocturia was mainly due to a mismatch between nocturnal urine volume and largest voided volume rather than abnormal values in either. The results also indicated that, from a community-perspective, nocturnal polyuria was the dominant pathogenic factor. Elderly patients with nocturia were treated with 0.2 mg peroral desmopressin for three consecutive nights. The short-term treatment was well tolerated and the absolute majority of patients did not experience any serum sodium value below the normal range. Logistic regression searching for risk factors for hyponatraemia showed increased risk with increasing age, concomitant cardiac disease and increasing 24-hour urine output. A database study including over 600 patients exposed to desmopressin verified that increasing age and 24-hour urine output increase the risk of hyponatraemia. Desmopressin-induced hyponatraemia follows the model of SIADH. Re-challenge of 5 women who developed hyponatraemia showed recurrence of hyponatraemia on the same dose regimen. Hyponatraemia was due to failure to decrease fluid intake in proportion to the reduction in diuresis and antidiuresis lasting 24-hours or more. The findings suggest that the prolonged antidiuresis was secondary to slow elimination of desmopressin rather than to an endogenous source of antidiuresis.
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| 7. |
- Rembratt, Åsa, et al.
(författare)
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What is nocturnal polyuria?
- 2002
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Ingår i: BJU International. - 1464-4096. ; 90:s3, s. 18-20
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Tidskriftsartikel (refereegranskat)
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