![]() ![]() Average values in all participants ( n = 27) of serum creatinine and C cr were 2.0 ± 0.4 mg/dl (173 ± 33 μmol/l) and 67 ± 9 ml/min/1.73 m 2, respectively. ![]() Resultsĭemographics of participants are summarized in Table 1. P-values of 0.05 or less were considered statistically significant. Multiple regression analysis was performed to identify independent variables to determine the night/day ratio of V, as a marker of polynocturia. The correlations among C cr and night/day ratios of MAP, V, U Na V, U K V, U urea V, U osm V and C H 2O were obtained by the method of least-squares. The significance in each parameter for day–night difference (nocturnal reduction) and CKD stage difference among the three groups in addition to the presence of their interaction (alternating action) was tested based on two-way ANOVA with repeated measures. The significance of differences among the three groups according to CKD stages was tested by one-way ANOVA, followed by Fisher's protected least significant difference post hoc test (PLSD test) to compare between groups A and C. Participants were divided into three groups with equal number of patients in each, to compare parameters according to kidney function: group A (normal kidney function CKD stage I n = 9), group B (mild-to-moderate reduction in Ccr CKD stages II and III n = 9), and group C (severe reduction in Ccr CKD stages IV and V n = 9). ![]() Twenty-seven patients with CKD (12 men and 15 women aged 20–80 years mean age 53 ± 4 years body weight 56.3 ± 3.0 kg, body mass index 21.8 ± 0.8 kg/m 2) were studied in Nagoya City University Hospital during hospitalization. Patients and methods Patients and study protocol Therefore, we examined whether nocturnal polyuria is due to free-water or osmotic diuresis, and whether osmotic diuresis is based on urea excretion or natriuresis during the night. On the other hand, we have recently reported that urinary sodium excretion during the night is enhanced as renal function deteriorates and as the circadian rhythm of blood pressure (BP) becomes non-dipper type, suggesting that nocturnal polyuria may be based on pressure-natriuresis during the night. It has been empirically thought that the capability to concentrate urine is impaired as renal function deteriorates, causing nocturnal polyuria as a precocious and ubiquitous symptom of chronic kidney disease (CKD). Furthermore, this increase in nocturnal urine volume seemed related to osmotic diuresis mainly by natriuresis rather than to water diuresis or urea excretion.īlood pressure, circadian rhythm, natriuresis, nocturnal polyuria, renal function Introduction As renal function deteriorated, nocturnal polyuria was seen, being consistent with classical recognition. Linear and multiple regression analysis identified nocturnal natriuresis rather than urea excretion as an independent determinant of nocturia.Ĭonclusion. C cr had significantly negative relationships with night/day ratios of V ( R = −0.69 P < 0.0001), U osm V ( R = −0.54 P = 0.004) and U Na V ( R = −0.63 P = 0.0005), but no correlation with night/day ratios of C H 2O ( R = −0.33 P = 0.1), U K V ( R = −0.29 P = 0.1) or U urea V ( R = −0.31 P = 0.1). Then, the night/day ratios of these parameters were analysed in relation to creatinine clearance (C cr) as a marker of glomerular filtration rate. In 27 CKD patients, circadian rhythms of urinary sodium, potassium, urea and osmolar excretion rates ( U Na V, U K V, U urea V, U osm V) as well as of urinary volume ( V) and free-water clearance (C H 2O) were estimated during both daytime (6:00 to 21:00) and nighttime (21:00 to 6:00). In the present study, we investigated whether nocturnal polyuria in CKD was due to the inability to concentrate urine, as previously proposed, or based on osmotic diuresis mainly by natriuresis. Recently, we found that as renal function deteriorated in chronic kidney disease (CKD), natriuresis was enhanced during the night with nocturnal blood pressure elevation. Nocturnal polyuria has been well known in renal insufficiency. ![]()
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