0823 Age-Related Changes in Nocturnal Urine Composition

Introduction In humans sleeping nocturnally, nocturnal polyuria (NP) refers to high rate of overnight urine production. NP is a heterogeneous condition that may reflect both free water and/or sodium diuresis, but the influence of age on differential fluid handling remains poorly understood. This study examined diuresis rate, sodium clearance, and free water clearance (FWC) by age, time of day (nighttime vs. daytime) and NP status (positive/negative) in subjects under entrained conditions sleeping nocturnally. Methods Convenience samples (age range 18-91; 82 men, 148 women) recruited from a urology ambulatory care unit (n=135) or continence clinic (n=95) collected 8 urine samples at 3-hour intervals over a single 24-hr period. Three separate mixed linear models were constructed for diuresis rate, sodium clearance, and FWC using four predictors: NP status (present [>90mL/h] vs. absent), time of day (night = 0100, 0400, 0700), age (as a continuous measure), and study source. Results Subjects with NP experienced both higher nighttime vs. daytime diuresis rate (1.89 vs. 1.44 mL/min, p<0.001), sodium clearance (0.91 vs. 0.74 mL/min, p<0.001), and FWC (-0.38 vs. -0.71 mL/min, p<0.001), whereas subjects without NP demonstrated lower nighttime vs. daytime diuresis rate (0.94 vs. 1.06, p=0.004) and no difference in sodium clearance (0.59 vs. 0.64, p=0.120) or FWC (-0.80 vs. -0.86, p=0.268). Regardless of NP status, FWC increased with age (p=0.039), and older age (>70) was accompanied by an increase in the ratio of nighttime/daytime diuresis rate and both nighttime and daytime sodium clearance. Conclusion Irrespective of NP, older adults experience proportionally greater nocturnal sodium clearance, as well as a complex surge in both daytime and nighttime FWC. The data imply that both nocturnal sodium clearance and FWC may reflect the relevant substrate underlying excess nocturnal urine production in elderly persons. Support N/A

Phenotyping nocturnal polyuria: circadian and age-related variations in diuresis rate, free water clearance and sodium clearance

Background this study compares diuresis rate, sodium clearance and free water clearance (FWC) by age and time of day (nighttime vs. daytime) in subjects with and without nocturnal polyuria (NP) to determine whether these variables affect the phenotype of NP. Methods post hoc analysis of two prospective observational studies. Eight urine samples collected at 3-h intervals and a single blood sample were used to calculate daytime (10a/1p/4p/7p/10p) and nighttime (1a/4a/7a) diuresis rates, sodium clearance and FWC. Three mixed linear models were constructed for diuresis rate, sodium clearance and FWC using four predictor variables: NP status (present [nocturnal urine production >90 ml/h] vs. absent [≤90 ml/h]), time of day, age and study identification. Results subjects with NP experienced higher nighttime versus daytime diuresis rates, sodium clearance and FWC. Regardless of NP status, increased age was accompanied by an increase in the ratio of nighttime/daytime diuresis rate, nighttime sodium clearance and daytime sodium clearance. FWC showed a complex age effect, which was independent of time of day or NP status. Conclusions age-related increases in nighttime/daytime diuresis rate, 24-h sodium clearance and 24-h FWC are not specific to subjects with NP. The age-related surge in either nocturnal sodium clearance or nocturnal FWC may represent the relevant substrate for behavioural or pharmacologic interventions targeting sodium diuresis or free water diuresis, respectively. Increases in FWC in older age groups may reflect impaired circadian rhythmicity of endogenous AVP or changes in responsiveness of the aged nephron to water clearance.

Age-related differences in water and sodium handling after commercial hydration beverage ingestion

Aging is associated with altered water, electrolyte, and glucose handling. Alternative beverages to those containing carbohydrate (CHO) should be considered for older adults. We hypothesized that reduced sodium (CNa+) and/or water (CH2O) clearance would underlie greater beverage retention in older compared with young adults, secondary to reduced glomerular filtration rate (GFR). We further hypothesized that amino acid (AA)- and CHO-based beverages would promote retention better than water. Over five visits, 12 young (23 ± 3 yr; 7 men, 5 women) and 12 older (67 ± 6 yr; 5 men, 7 women) subjects consumed 1 liter of distilled water or beverages with 6% CHO, 0.46 g/l Na+ [Gatorade (GAT)]; 2.5% CHO, 0.74 g/l Na+ [Pedialyte (PED)]; 5 AA, 1.04 g/l Na+ [enterade (ENT)-5]; or 8 AA, 1.38 g/l Na+ (ENT-8) over 30 min. Blood and urine were collected every hour for 4 h after ingestion; retention, CH2O, and CNa+ were calculated at 2 and 4 h. Additional calculations adjusted CH2O and CNa+ for estimated GFR (eGFR). Water yielded the lowest retention in both groups ( P ≤ 0.02). Retention was higher in older vs. young adults except for ENT-8 at 4 h ( P = 0.73). CH2O was higher for older vs. young adults for GAT at 2 h ( P < 0.01) and GAT and PED at 4 h ( P < 0.01) after ingestion but was otherwise similar between groups. CNa+ was lower in older vs. young adults except for ENT-8 ( P ≥ 0.19). Adjusting for eGFR resulted in higher CH2O for all beverages in older vs. young adults ( P < 0.05) but did not influence CNa+. Older adults may better retain beverages with less Na+ than young adults because of reduced CNa+. AA- and CHO-based electrolyte-rich beverages may similarly promote beverage retention. NEW & NOTEWORTHY Commercially available amino acid (AA)-containing beverages may provide an alternative to traditional carbohydrate (CHO)-containing beverages, particularly for older adults with attenuated water, electrolyte, and glucose handling. We compared beverage retention and free water and sodium clearance between young and older adults after ingestion of water, two CHO-based beverages, and two AA-based beverages. Our data suggest that older adults better retain beverages with less sodium compared with young adults and that AA-based and CHO-based electrolyte-containing beverages similarly promote retention.

Observations on some renal function indices in dogs under ketamine-xylazine anaesthesia

This study was done to evaluate the effect of an increased dose of ketamine on some renal function indices of Ketamine−Xylazine anaesthetised dogs. Five adult female mongrel dogs assigned to two different treatment groups in a randomized cross over design were used for this study. Each of the dogs received either 10mg/kg or 20mg/kg ketamine at a week interval. The mean glomerular filtration rate (GFR) of creatinine, absolute and fractional excretion of sodium (UNaV, FENa), urine flow rate (UFR), and plasma sodium clearance were all found to be insignificantly increased in dogs that received the higher dose regime of ketamine. All the dogs in the two treatment groups exhibited levels of glycosuria and hyposthenuria. When plasma sodium concentration of dogs treated with 10mg/kg was correlated with UNaV it was found to be significant and strong (P < 0.05; r =0.86). It was however strong but insignificant with sodium clearance (P>0.05; r = 0.82) and creatinine clearance (P> 0.05; r = 0.39). At 20mg/kg, the UNaV, sodium clearance and glomerular filtration rate all correlated weakly and insignificantly with plasma sodium concentration. The enhanced diuresis and natriuresis observed in the two treatment groups could be attributed to the effect of xylazine on either the alpha-2 adrenoceptor of the brain or those on the tubules of the kidney. These effects of xylazine could not be reversed by attempting to competitively antagonize it with a 100% increase in ketamine dose.Keywords: Diuresis, GFR fractional excretion, Ketamine, Natriuresis, xylazine

Renal regulation of sodium, potassium and chloride balance in single- and twin-pregnant goats

The aim of these studies was to analyse and compare changes in selected parameters of renal function in terms of water-electrolyte balance regulation in single- and twin-pregnant goats. Clearance analyses were carried out on 16 pregnant White Improved goats (8 in single and 8 in twin gestation). Blood plasma and urine samples were analysed for the concentration of inulin, endogenous creatinine, sodium, potassium, and chlorides. It has been demonstrated that glomerular filtration rate (GFR) in the goat kidney does not change significantly during gestation. GFR recorded from the 1st week until the 20th week of gestation in twin-pregnant goats was only slightly higher compared to those observed in single-pregnant does. Blood plasma concentrations of major electrolytes, i.e. sodium, potassium and chloride ions, did not differ significantly in pregnant and non-pregnant goats, and remained within the reference values. From the very beginning of gestation, the single-pregnant goats showed increased renal potassium clearance; however, the level of sodium clearance remained stable. On the other hand, sodium clearance increased from the 2nd month of gestation in the twin-pregnant goats, while the load of excreted potassium did not change. These changes had probably resulted from varied levels of aldosterone and progesterone and their mutual proportions differing between the groups.

Diuretic effect of hypoxia, hypocapnia, and hyperpnea in humans: relation to hormones and O2 chemosensitivity

We studied the contributions of hypoxemia, hypocapnia, and hyperpnea to the acute hypoxic diuretic response (HDR) in humans and evaluated the role of peripheral O2 chemosensitivity and renal hormones in HDR. Thirteen healthy male subjects (age 19–38 yr) were examined after sodium equilibration (intake: 120 mmol/day) during 90 min of normoxia (NO), poikilocapnic hypoxia (PH), and isocapnic hypoxia (IH) ( days 1–3, random order, double blind), as well as normoxic voluntary hyperpnea (HP; day 4), matching ventilation during IH. O2 saturation during PH and IH was kept equal to a mean level measured between 30 and 90 min of breathing 12% O2 in a pretest. Urine flow during PH and IH (1.81 ± 0.92 and 1.94 ± 1.03 ml/min, respectively) but not during HP (1.64 ± 0.96 ml/min) significantly exceeded that during NO (control, 1.38 ± 0.71 ml/min). Urine flow increases vs. each test day's baseline were significant with PH, IH, and HP. Differences in glomerular filtration rate, fractional sodium clearance, urodilatin, systemic blood pressure, or leg venous compliance were excluded as factors of HDR. However, slight increases in plasma and urinary endothelin-1 and epinephrine with PH and IH could play a role. In conclusion, the early HDR in humans is mainly due to hypoxia and hypocapnia. It occurs without natriuresis and is unrelated to O2 chemosensitivity (hypoxic ventilatory response).