Spot urine versus 24-hour urine collection for estimation of the generation of uremic toxins originating from gut microbial metabolism

Abstract Background Monitoring sodium intake through 24-h urine collection sample is recommended, but the implementation of this method can be difficult. The objective of this study was to develop and validate an equation using spot urine concentration to predict 24-h sodium excretion in the Malaysian population. Methods This was a Malaysian Community Salt Study (MyCoSS) sub-study, which was conducted from October 2017 to March 2018. Out of 798 participants in the MyCoSS study who completed 24-h urine collection, 768 of them have collected one-time spot urine the following morning. They were randomly assigned into two groups to form separate spot urine equations. The final spot urine equation was derived from the entire data set after confirming the stability of the equation by double cross-validation in both study groups. Newly derived spot urine equation was developed using the coefficients from the multiple linear regression test. A Bland-Altman plot was used to measure the mean bias and limits of agreement between estimated and measured 24-h urine sodium. The estimation of sodium intake using the new equation was compared with other established equations, namely Tanaka and INTERSALT. Results The new equation showed the least mean bias between measured and predicted sodium, − 0.35 (− 72.26, 71.56) mg/day compared to Tanaka, 629.83 (532.19, 727.47) mg/day and INTERSALT, and 360.82 (284.34, 437.29) mg/day. Predicted sodium measured from the new equation showed greater correlation with measured sodium (r = 0.50) compared to Tanaka (r =0.24) and INTERSALT (r = 0.44), P < 0.05. Conclusion Our newly developed equation from spot urine can predict least mean bias of sodium intake among the Malaysian population when 24-h urine sodium collection is not feasible.

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Abstract MP78: Validity of Predictive Equations for 24-Hour Urine Sodium Excretion in Young Black and Other Adults

Circulation ◽

10.1161/circ.127.suppl_12.amp78 ◽

2013 ◽

Vol 127 (suppl_12) ◽

Author(s):

Mary Cogswell ◽

Chia-Yih Wang ◽

Te-Ching Chen ◽

Christine Pfeiffer ◽

Paul Elliott ◽

...

Keyword(s):

Sodium Excretion ◽

Sodium Intake ◽

Urine Collection ◽

Urine Sodium ◽

Predictive Equations ◽

Spot Urine ◽

Individual Level ◽

Urine Sodium Excretion ◽

Mean Differences ◽

The Individual

Introduction: Reducing mean population sodium intake by ~1200 mg is projected to reduce thousands of deaths from heart disease and stroke and save billions of health care dollars annually. Twenty-four hour urine collection is recommended for assessing changes in mean population sodium intake, but can be difficult to implement. Predicting 24-hour urine sodium excretion using spot urines is not recommended due to diurnal variations in excretion. Further, sodium excretion patterns differ between black and white persons. We assessed the validity of previously published prediction equations for 24-hour sodium excretion in black and other young adults by timing of spot urine collection. Design: Of 481 adult volunteers aged 18-39 years (50% Blacks) asked to participate in a 2011 study in the Metropolitan DC area, 407 collected each urine void in a separate container for 24 hours. Four timed voids from the 24-h urine collection were selected (morning, afternoon, evening, and overnight) to use with previously published predictive equations. Predictive equations were based on one of two approaches; 1) an indirect approach using spot urine sodium-to-creatinine concentrations and predicted 24-hour creatinine excretion ( Tanaka, Kawasaki, Mage ), and 2) a direct approach using spot urine sodium, potassium, and creatinine concentrations, and age, and body mass index with separate equations by sex ( Brown ). We assessed mean differences between predicted and measured 24-hour sodium excretion (bias) and individual differences across levels of sodium excretion using Bland-Altman plots. Results: Among participants, mean measured 24-hour sodium excretion was ~3300 mg (SD ~1400 mg). Of the equations evaluated, mean bias in predicted 24-hour sodium excretion was least from Brown equations when using morning (-165 mg, 95% confidence interval [CI], -295, -36 mg), afternoon (-90 mg, 95% CI, -208, 28 mg) or evening ( -120 mg, 95% CI -230, -11 mg) spot urines. When using overnight spot urines, mean bias from Brown equations was greatest and statistically significant (-247 mg, 95% CI, -348, -151 mg). When using overnight spot urines, mean bias from Tanaka (-23 mg) or Mage (-145 mg) equations was not significant, however, when stratified by sex, mean biases were significant and in opposite directions. Among Blacks, mean biases from Brown were not significant (-167 to 122 mg) except using overnight specimens among Black females (-267 mg, 95% CI, -525, -47 mg). Across equations and time periods, Bland-Altman plots indicated significant bias at the individual level. Conclusions: Of the evaluated equations, predicted 24-hour urine sodium excretion using the Brown equations with morning, afternoon, or evening specimens may provide the least biased estimates of group mean sodium intake among young US adults. None of the equations adequately predicted individual 24-hour sodium excretion measured on the same day.

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Spot urine and 24-h diet recall estimates of dietary sodium intake from the 2008/09 New Zealand Adult Nutrition Survey: a comparison

10.26686/wgtn.12831818 ◽

2020 ◽

Author(s):

RM McLean ◽

SM Williams ◽

Lisa Te Morenga ◽

JI Mann

Keyword(s):

New Zealand ◽

Sodium Excretion ◽

Sodium Intake ◽

Urinary Sodium Excretion ◽

Dietary Sodium ◽

Urine Collection ◽

Limits Of Agreement ◽

Nutrition Survey ◽

Spot Urine ◽

Diet Recall

© 2018, Macmillan Publishers Limited, part of Springer Nature. Background: We aimed to test the difference between estimates of dietary sodium intake using 24-h diet recall and spot urine collection in a large sample of New Zealand adults. Methods: We analysed spot urine results, 24-h diet recall, dietary habits questionnaire and anthropometry from a representative sample of 3312 adults aged 15 years and older who participated in the 2008/09 New Zealand Adult Nutrition Survey. Estimates of adult population sodium intake were derived from 24-h diet recall and spot urine sodium using a formula derived from analysis of INTERSALT data. Correlations, limits of agreement and mean difference were calculated for the total sample, and for population subgroups. Results: Estimated total population 24-h urinary sodium excretion (mean (95% CI)) from spot urine samples was 3035 mg (2990, 3079); 3612 mg (3549, 3674) for men and 2507 mg (2466, 2548) for women. Estimated mean usual daily sodium intake from 24-h diet recall data (excluding salt added at the table) was 2564 mg (2519, 2608); 2849 mg (2779, 2920) for men and 2304 mg (2258, 2350) for women. Correlations between estimates were poor, especially for men, and limits of agreement using Bland–Altman mean difference analysis were wide. Conclusions: There is a poor agreement between estimates of individual sodium intake from spot urine collection and those from 24-hour diet recall. Although, both 24-hour dietary recall and estimated urinary excretion based on spot urine indicate mean population sodium intake is greater than 2 g, significant differences in mean intake by method deserve further investigation in relation to the gold standard, 24-hour urinary sodium excretion.

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Estimation of 24-Hour Urine Phosphate Excretion From Spot Urine Collection: Development of a Predictive Equation

Journal of Renal Nutrition ◽

10.1053/j.jrn.2014.02.001 ◽

2014 ◽

Vol 24 (3) ◽

pp. 194-199 ◽

Cited By ~ 10

Author(s):

Cassianne Robinson-Cohen ◽

Joachim H. Ix ◽

Gerard Smits ◽

Martha Persky ◽

Glenn M. Chertow ◽

...

Keyword(s):

Collection Development ◽

Urine Collection ◽

Predictive Equation ◽

Spot Urine ◽

Phosphate Excretion

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A Simple Method to Evaluate Residual Renal Function by Spot Urinary Cystatin C-to-Creatinine Ratio in Peritoneal Dialysis Patients

Peritoneal Dialysis International ◽

10.3747/pdi.2009.00045 ◽

2010 ◽

Vol 30 (4) ◽

pp. 464-467 ◽

Cited By ~ 5

Author(s):

Yoko Adachi ◽

Akira Nishio

Keyword(s):

Renal Function ◽

Peritoneal Dialysis ◽

Cystatin C ◽

Screening Method ◽

Residual Renal Function ◽

Urine Collection ◽

Creatinine Ratio ◽

Simple Method ◽

Spot Urine ◽

Urinary Cystatin C

Residual renal function (RRF) is a key element in the management of chronic peritoneal dialysis (PD) patients, and 24-hour creatinine clearance (24-h Ccr) and arithmetic mean of creatinine and urea nitrogen clearances [24-h (Ccr+Curea)/2] are still standard clinical techniques for the assessment of glomerular filtration rate (GFR) to represent RRF. However, it is sometimes difficult to monitor urine collection for 24 hours, especially in outpatients, and it requires serum sampling. Therefore, we devised a new and simple method to measure RRF in prevalent PD patients. Levels of urinary cystatin C (Cys-C) and creatinine in spot urine samples [24-h (Ccr+Curea)/2] were measured in 15 stable Japanese PD patients. Although no statistical correlation was seen between Cys-C and 24-h (Ccr+Curea)/2 values, a strong correlation was found between the spot urine Cys-C-to-creatinine ratio [U (Cys-C/Cr)] and 24-h (Ccr+Curea)/2. By simple linear regression analysis, the following regression equation was derived: y = 17.0 – 6.1x, where x = log 10000*U (Cys-C/Cr) ratio and y = 24-h (Ccr+Curea)/2. Measurement of U (Cys-C/Cr) ratio does not require serum sampling or 24-hour urine collection but requires only a spot urine sample. We suggest that the U (Cys-C/Cr) ratio is a simple and easy screening method to estimate GFR in PD patients.

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U Michigan - Spot urine collection v2 (protocols.io.56fg9bn)

protocols.io ◽

10.17504/protocols.io.56fg9bn ◽

2019 ◽

Author(s):

Jeff Hodgin

Keyword(s):

Urine Collection ◽

Spot Urine

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Uremic toxins originating from colonic microbial metabolism

Kidney International ◽

10.1038/ki.2009.402 ◽

2009 ◽

Vol 76 ◽

pp. S12-S19 ◽

Cited By ~ 235

Author(s):

Pieter Evenepoel ◽

Bjorn K.I. Meijers ◽

Bert R.M. Bammens ◽

Kristin Verbeke

Keyword(s):

Microbial Metabolism ◽

Uremic Toxins

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Measurement of urinary 5-HIAA: correlation between spot versus 24-h urine collection

Endocrine Connections ◽

10.1530/ec-19-0269 ◽

2019 ◽

Vol 8 (8) ◽

pp. 1082-1088 ◽

Cited By ~ 3

Author(s):

Matilde Calanchini ◽

Michael Tadman ◽

Jesper Krogh ◽

Andrea Fabbri ◽

Ashley Grossman ◽

...

Keyword(s):

Reference Method ◽

Neuroendocrine Neoplasms ◽

Urine Collection ◽

Creatinine Concentration ◽

Spot Urine ◽

Reference Limit ◽

Spot Urine Sample ◽

Hydroxyindoleacetic Acid ◽

Upper Reference Limit

Background The 24-h urinary output of 5-hydroxyindoleacetic acid (5-HIAA) is used to monitor disease progression and treatment responses of neuroendocrine neoplasms (NENs). Several conditions are required for 5-HIAA assay, involving urine collection/preservation and food/drug restrictions. Aim To evaluate the correlation between 5-HIAA concentration in a spot urine sample and the output in a 24-h urine collection, and whether spot urine specimens can replace 24-h collection. Methods Patients with NENs or symptoms suggestive of NENs were asked to provide a separate spot urine at the end of the 24-h urine collection for 5-HIAA assessment. The upper reference limit for 24-h urinary 5-HIAA was 40 µmol/24 h. 5-HIAA measurements in spot urine samples were corrected for variation in urine flow rate by expressing results as a ratio to creatinine concentration. Results We included 136 paired urinary samples for 5-HIAA assessment from 111 patients (100 NENs). The correlation between 5-HIAA values measured in 24-h and spot urines was r = +0.863 (P < 0.001) and r = +0.840 (P < 0.001) including only NEN patients. Using the 24-h urinary 5-HIAA as reference method, the AUC on ROC analysis for spot urinary 5-HIAA was 0.948 (95% CI, 0.914–0.983; P < 0.001), attaining a sensitivity of 83% and specificity of 95% using 5.3 mol/mmol as cut-off for the spot urine. The AUC among NEN patients alone was 0.945 (95% CI, 0.904–0.987; P < 0.001). Conclusions The ratio of 5-HIAA to creatinine in a spot urine could replace the measurement of 5-HIAA output in a 24-h urine collection, especially for follow-up of patients with known elevated 5-HIAA levels.

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Spot urine and 24-h diet recall estimates of dietary sodium intake from the 2008/09 New Zealand Adult Nutrition Survey: a comparison

10.26686/wgtn.12831818.v1 ◽

2020 ◽

Author(s):

RM McLean ◽

SM Williams ◽

Lisa Te Morenga ◽

JI Mann

Keyword(s):

New Zealand ◽

Sodium Excretion ◽

Sodium Intake ◽

Urinary Sodium Excretion ◽

Dietary Sodium ◽

Urine Collection ◽

Limits Of Agreement ◽

Nutrition Survey ◽

Spot Urine ◽

Diet Recall

© 2018, Macmillan Publishers Limited, part of Springer Nature. Background: We aimed to test the difference between estimates of dietary sodium intake using 24-h diet recall and spot urine collection in a large sample of New Zealand adults. Methods: We analysed spot urine results, 24-h diet recall, dietary habits questionnaire and anthropometry from a representative sample of 3312 adults aged 15 years and older who participated in the 2008/09 New Zealand Adult Nutrition Survey. Estimates of adult population sodium intake were derived from 24-h diet recall and spot urine sodium using a formula derived from analysis of INTERSALT data. Correlations, limits of agreement and mean difference were calculated for the total sample, and for population subgroups. Results: Estimated total population 24-h urinary sodium excretion (mean (95% CI)) from spot urine samples was 3035 mg (2990, 3079); 3612 mg (3549, 3674) for men and 2507 mg (2466, 2548) for women. Estimated mean usual daily sodium intake from 24-h diet recall data (excluding salt added at the table) was 2564 mg (2519, 2608); 2849 mg (2779, 2920) for men and 2304 mg (2258, 2350) for women. Correlations between estimates were poor, especially for men, and limits of agreement using Bland–Altman mean difference analysis were wide. Conclusions: There is a poor agreement between estimates of individual sodium intake from spot urine collection and those from 24-hour diet recall. Although, both 24-hour dietary recall and estimated urinary excretion based on spot urine indicate mean population sodium intake is greater than 2 g, significant differences in mean intake by method deserve further investigation in relation to the gold standard, 24-hour urinary sodium excretion.

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Diagnostic usefulness of the spot urine sodium/potassium ratio in cirrhotic patients with ascites

PLoS ONE ◽

10.1371/journal.pone.0253886 ◽

2021 ◽

Vol 16 (6) ◽

pp. e0253886

Author(s):

Jin Wook Lee ◽

Jae Seok Hwang ◽

Woo Jin Chung ◽

Heon Ju Lee ◽

Jung Gil Park ◽

...

Keyword(s):

Urine Samples ◽

Urine Collection ◽

Urine Sodium ◽

Salt Diet ◽

Spot Urine ◽

Number Of Patients ◽

Low Salt ◽

Diagnostic Usefulness ◽

Diet Compliance ◽

Cirrhotic Patients

Background and aims The low-salt diet is considered important for control of ascites in cirrhotic patients. To validate whether the spot urine sodium (Na)/potassium (K) ratio could replace 24-h urine Na (uNa) excretion in assessing low-salt diet compliance. Methods We prospectively studied 175 patients. 24-h urine collection and spot urine collection were performed. Subsequently, 24-h uNa, urine creatinine (uCr), and spot urine Na and K were assessed. A complete urine collection was confirmed based on 24-h uCr excretion levels of 15mg/kg/day for men and 10mg/kg/day for women. The area under the receiver operating characteristic (AUROC) curve analysis was performed to evaluate the feasibility of spot urine Na/K ratio in predicting 24-h uNa greater than 78mmol/day. Results Out of 175 patients, 24-h urine samples were completely collected in 57 patients only. Moreover, urine samples were not completely collected in 118 patients because their 24-h uCr excretion level was less than the established criteria. In complete urine collection group, AUROC curve for spot urine Na/K ratio in predicting 24-h uNa greater than 78mmol/day was 0.874±0.051 (P<0.001). In the incomplete urine collection group, the AUROC was 0.832±0.039 (P<0.001). In complete urine collection group, the classical cutoff value greater than 1.0 of spot urine Na/K ratio showed 90.9% sensitivity and 56.0% specificity. Conclusions The spot urine Na/K ratio reflects 24-h uNa, but the AUROC value obtained in this study is lower than that of a previous study. Considered the large number of patients with incomplete urine collection, validating 24-h complete urine collection criteria is necessary.

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