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Nocturia and chronic kidney disease; systematic review and nominal group technique consensus for primary care assessment and treatment

Ridgway, Alex; Cotterill, Nikki; Dawson, Shoba; Drake, Marcus J; Henderson, Emily J; Huntley, Alyson L; Rees, Jonathan; Strong, Eddie; Dudley, Christopher; Udayaraj, Udaya

Authors

Alex Ridgway

N Nikki Cotterill Nikki.Cotterill@uwe.ac.uk
Professor of Long Term Conditions (Continence Care)

Shoba Dawson

Marcus J Drake

Emily J Henderson

Alyson L Huntley

Jonathan Rees

Eddie Strong

Christopher Dudley

Udaya Udayaraj



Abstract

Context: Reduced renal function impairs salt and water homeostasis, which can drive nocturnal or 24-hour polyuria. Nocturia can arise early in chronic kidney disease (CKD). Evidence-based recommendations can facilitate management outside nephrology clinics.

Objective: systematic review (SR) of nocturia in CKD, and expert consensus for management in primary care and in specialist clinics outside nephrology.

Evidence Acquisition: Four databases were searched from January 2000-April 2020. 4011 titles and abstracts were screened, and 108 studies underwent full-text screening. Seven met the inclusion criteria and two were identified through other sources. Consensus was derived from an expert panel with public involvement using Nominal Group Technique (NGT).

Evidence Synthesis: Several plausible mechanisms contribute to nocturnal or 24-hour polyuria in CKD, but there is little evidence on interventions to improve nocturia. NGT assessment recommendations for nocturia (at least twice per night) in patients with CKD or at risk of CKD being assessed in a non-nephrology setting were: history (thirst, fluid intake), medication review (diuretics, lithium, calcium channel antagonists, non-steroidal anti-inflammatory medications), examination (oedematous state, blood pressure), urinalysis (haematuria and albumin: creatinine ratio) blood tests (blood urea, serum creatinine and electrolytes, eGFR), bladder diary. Renal ultrasound follows local CKD guidelines. Treatment options include optimising blood pressure control, dietary adjustment to reduce salt intake, fluid advice, medication review. Referral to specialist nephrology services should follow local guidelines.

Conclusion: CKD should be considered when evaluating patients with nocturia. Assessment aims to identify mechanisms and instigate therapy, but the latter may be more applicable to reducing wider morbidity associated with CKD than nocturia itself.

Patient Summary. People with kidney disease can suffer severe sleep disturbance from passing urine overnight. We looked at published research and found some useful information about mechanisms. A group of experts was able to develop practical approaches for assessing and treating the situation.

Citation

Ridgway, A., Cotterill, N., Dawson, S., Drake, M. J., Henderson, E. J., Huntley, A. L., …Udayaraj, U. (in press). Nocturia and chronic kidney disease; systematic review and nominal group technique consensus for primary care assessment and treatment. European Urology Focus, https://doi.org/10.1016/j.euf.2021.12.010

Journal Article Type Article
Acceptance Date Dec 28, 2021
Online Publication Date Jan 11, 2022
Deposit Date Jan 14, 2022
Publicly Available Date Jan 12, 2023
Publisher Elsevier
Peer Reviewed Peer Reviewed
DOI https://doi.org/10.1016/j.euf.2021.12.010
Public URL https://uwe-repository.worktribe.com/output/8564484