Nocturia and Chronic Kidney Disease: Systematic Review and Nominal Group Technique Consensus on Primary Care Assessment and Treatment

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

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

Abstract

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

Objective
To conduct a systematic review (SR) of nocturia in CKD and achieve expert consensus for management in primary care and in specialist clinics outside nephrology.

Evidence acquisition
Four databases were searched from January 2000 to April 2020. A total of 4011 titles and abstracts were screened, and 108 studies underwent full-text screening. Seven studies met the inclusion criteria and two were identified through other sources. Consensus was achieved among an expert panel with public involvement using the nominal group technique (NGT).

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

Conclusions
CKD should be considered when evaluating patients with nocturia. The aim of assessment is 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 because of a need to pass urine overnight. We looked at published research and found some useful information about the underlying mechanisms. A group of experts was able to develop practical approaches for assessing and treating this condition.
Original languageEnglish
Pages (from-to)18-25
Number of pages8
JournalEuropean Urology Focus
Volume8
Issue number1
Early online date12 Jan 2022
DOIs
Publication statusE-pub ahead of print - 12 Jan 2022

Bibliographical note

Funding Information:
Funding/Support and role of the sponsor: This project was funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) programme (grant reference number NIHR RfPB PB-PG-1217-20034). The sponsor played no direct role in the study. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

Funding Information:
The authors would like to thank Dr. Charles Tomson, Department of Renal Medicine, Freeman Hospital, Newcastle upon Tyne, UK; and Professor Christopher Pugh, Nuffield Department of Medicine, University of Oxford, Oxford, UK for their valuable contribution to the NGT consensus sessions.

Publisher Copyright:
© 2021 European Association of Urology

Keywords

  • Nocturia
  • Lower urinary tract symptoms
  • Chronic Kidney Disease
  • Systematic review
  • Nominal Group Technique

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