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NDT Advance Access published online on April 20, 2006
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfl165
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© The Author [2006]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Received January 22, 2006
Accepted March 14, 2006

Original Article

Polynocturia in chronic kidney disease is related to natriuresis rather than to water diuresis

Michio Fukuda 1 *, Masahiro Motokawa 1, Sota Miyagi 1, Kinya Sengo 1, Wataru Muramatsu 1, Nobuo Kato 1, Takeshi Usami 1, Atsuhiro Yoshida 1, and Genjiro Kimura 1

1 Department of Internal Medicine and Pathophysiology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan

* To whom correspondence should be addressed.
Michio Fukuda, E-mail: momoca{at}sage.ocn.ne.jp



  Abstract

Background. Nocturnal polyuria has been well known in renal insufficiency. Recently, we found that as renal function deteriorated in chronic kidney disease (CKD), natriuresis was enhanced during the night with nocturnal blood pressure elevation. 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.

Methods. In 27 CKD patients, circadian rhythms of urinary sodium, potassium, urea and osmolar excretion rates (UNaV, UKV, UureaV, UosmV) as well as of urinary volume (V) and free-water clearance (CHH2O) were estimated during both daytime (6:00 to 21:00) and nighttime (21:00 to 6:00). Then, the night/day ratios of these parameters were analysed in relation to creatinine clearance (Ccr) as a marker of glomerular filtration rate.

Results. Ccr had significantly negative relationships with night/day ratios of V (R = -0.69; P < 0.0001), UosmV (R = -0.54; P = 0.004) and UNaV (R = -0.63; P = 0.0005), but no correlation with night/day ratios of CHH2O (R = -0.33; P = 0.1), UKV (R = -0.29; P = 0.1) or UureaV (R = -0.31; P = 0.1). Linear and multiple regression analysis identified nocturnal natriuresis rather than urea excretion as an independent determinant of nocturia.

Conclusion. As renal function deteriorated, nocturnal polyuria was seen, being consistent with classical recognition. Furthermore, this increase in nocturnal urine volume seemed related to osmotic diuresis mainly by natriuresis rather than to water diuresis or urea excretion.

Keywords: blood pressure; circadian rhythm; natriuresis; nocturnal polyuria; renal function.
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