Prevalence and risk factors for nocturia in middle-aged and elderly people from public health centers in Taiwan

Association of nocturia of self-report with estimated glomerular filtration rate: a cross-sectional study from the NHANES 2005-2018

Nocturia is a manifestation of systemic diseases, in which chronic kidney disease (CKD) is an independent predictor of nocturia due to its osmotic diuretic mechanism. However, to our knowledge, previous studies have not examined the association between nocturia and estimated glomerular filtration rate (eGFR). The purpose of this study was to assess the association between nocturia exposure and eGFR in the general US population. This study presents a cross-sectional analysis of the general US population enrolled in the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2018. To account for potential confounding factors, linear regression analysis was conducted to investigate the association between nocturia and eGFR. Stratified analyses and interaction tests were employed to examine the variables of interest. Additionally, sensitivity analyses were conducted across diverse populations. A total of 12,265 individuals were included in the study. After controlling for confounding factors, the results of the linear regression analysis indicated that a single increase in nocturnal voiding frequency was associated with a decrease in eGFR by 2.0 mL/min/1.73 m2. In comparison to individuals with a nocturnal urinary frequency of 0, those who voided 1, 2, 3, 4, and ≥ 5 times at night experienced a decrease in eGFR by 3.1, 5.4, 6.4, 8.6 and 4.0 mL/min/1.73 m2, respectively. Nocturia was found to be associated with a decreased eGFR of 4 mL/min/1.73 m2 when compared to individuals without nocturia. The sensitivity analysis yielded consistent findings regarding the association between nocturia and eGFR in both CKD and non-CKD populations, as well as in hypertensive and non-hypertensive populations. Nevertheless, inconsistent conclusions were observed across various prognostic risk populations within the CKD context. The presence of nocturia and heightened frequency of nocturnal urination have been found to be associated with a decline in eGFR.

The association between diabetes and nocturia: A systematic review and meta-analysis

Background

Many studies have explored the association between diabetes and nocturia, but it remains unclear. This article systematically analyses existing evidence of the relationship between diabetes and nocturia, including subgroup analysis based on the number of voids, gender, and continent, in the hope of reaching more reliable clinical conclusions relating to diabetes and nocturia.

Methods

PubMed, Web of Science, and Cochrane Library were searched for identifying studies relating to diabetes and nocturia prior to July 2021. Literature quality evaluation was performed using the Newcastle Ottawa Scale. A random effect meta-analysis was used for pooled odds ratios (ORs) and confidence intervals (CIs) as a means of evaluating the relationship between diabetes and nocturia.

Results

In total, 29 of 781 potentially relevant studies were proven to be eligible. The overall pooled OR demonstrated that diabetes increases the risk of nocturia (OR: 1.49; 95% CI: 1.38, 1.61; P < 0.00001). The association was found to be more robust among subjects ≥ 1 void than ≥ 2 void (OR: 1.74; 95% CI: 1.41, 2.14; P < 0.00001 vs. OR: 1.45; 95% CI: 1.33, 1.59; P < 0.00001), in males than females (OR: 1.59; 95% CI: 1.41, 1.79; P < 0.00001 vs. OR: 1.41; 95% CI: 1.20, 1.66; P < 0.0001) and in Asia than Europe or North America (OR: 1.54; 95% CI: 1.36, 1.75; P < 0.00001 vs. OR: 1.43; 95% CI: 1.19, 1.72; P = 0.0001 vs. OR: 1.45; 95% CI: 1.22, 1.73; P < 0.0001).

Conclusions

Diabetes has an association with a 1.49-fold higher risk of nocturia. This association is more robust for Asian and male subjects or those at a lower nocturia cut-off.

Central hemodynamics, vascular stiffness, and nocturia in patients with type 2 diabetes

Recently, studies have shown that the presence of nocturia may not be a benign condition and related with systemic illness and mortality. Elevated blood pressure (BP) was another factor related with nocturia. Type 2 diabetes mellitus (T2DM) is also associated with nocturia. It is now clear that, apart from peripheral BP, central hemodynamic parameters are important for cardiovascular prognosis. However, no previous study in the literature examined the relationship between nocturia and central hemodynamic parameters in patients with T2DM. The current study was designed to examine these relationships. Nocturia was defined as two or more voids per night. Central hemodynamic parameters were assessed from ambulatory BP measurements. In addition to routine biochemistry, 24-h urine collection was performed to measure protein, albumin, and sodium excretion. 158 patients (52.3%) had T2DM and 144 (47.7%) did not have T2DM (control group). The presence of T2DM was independently related with nocturia. Both in whole group and in T2DM patients, most of the hemodynamic parameters are higher in patients with nocturia compared to patients without nocturia. Among patients with T2DM, nocturia was associated with augmentation index and pulse wave velocity. In conclusion, central hemodynamic parameters and markers of vascular stiffness may be related with nocturia in patients with T2DM.

Nocturia in patients with benign prostatic hyperplasia: evaluating the significance of ageing, co-morbid illnesses, lifestyle and medical therapy in treatment outcome in real life practice

AIM

The aim of study was to evaluate the influence of ageing, lifestyle, and co morbid illnesses on treatment outcome of nocturia among men with BPH.

METHODS

Patients with BPH on medical therapy of least 6 months and up to 48 months were interviewed. Nocturia episodes, co morbid illnesses, beverage intake frequency, medications and work history were documented. Body Mass Index (BMI), waist circumference (WC), prostate volume, and prostate specific antigen (PSA) were recorded. Treatment failure is defined as persistent nocturia despite on medical therapy for BPH.

RESULTS

In 156 patients, the prevalence of nocturia was 96.7% while nocturia of 2 or more was 85.9%. Factors associated with treatment failure was older age (p < 0.01), usage of diuretics (p = 0.03), and antimuscarinics (p < 0.01), while active working status (p < 0.01), use of desmopression (p = 0.01), and increased coffee intake (p = 0.02) were associated with nocturia improvement. Co-morbid illnesses, obesity, WC, alcohol intake, PSA, prostate volume, and use of BPH medical therapy did not influence treatment outcome.

CONCLUSION

Advancing age has a significance negative outcome on nocturia treatment, while standard BPH medical therapy and co morbid illnesses have an insignificant impact. However, alleviation of bothersome symptoms is possible with the understanding of its patho-physiology and individual-based approach to treatment and expected outcome.