Nocturia

Orinar interrumpiendo el sueño nocturno es conocido como nocturia. Perjudica el sueño y la calidad de vida. Es un síntoma de que algo no funciona bien: enfermedad, metabolismo, ritmos circadianos, etc [1].

#IDEAS

¿Evitar potasio a la noche? ¿Reducir carbohidratos cuando hago menos ejercicio? ¿Cenar antes? En rutas por montaña de varios días rara vez orino durante la noche.

Nocturia is one of the cardinal symptoms of overactive bladder.

The aetiology of nocturia is multifactorial, with causes such as hypertension, heart disease, diabetes mellitus, lower limb oedema, and lung disease, which are commonly associated with polyuria, as well as neurological diseases and urinary incontinence.

MIRZAYEVA, Nurlana, et al. Bryophyllum pinnatum and Improvement of Nocturia and Sleep Quality in Women: A Multicentre, Nonrandomised Prospective Trial. Evidence-Based Complementary and Alternative Medicine, 2023, vol. 2023.

Para un diagnóstico más preciso:

AUCAR, Nahir, et al. Nocturia: its characteristics, diagnostic algorithm and treatment. International Urology and Nephrology, 2023, vol. 55, no 1, p. 107-114.

 

Reduction of daily salt intake reduced nocturnal urinary volume and nocturnal polyuria index in patients with excessive salt intake.

Fluid and salt retention. In health, excess dietary fluid and salt are preferentially excreted during waking hours. This effect may become blunted in CKD, resulting in compensatory nocturnal natriuresis and polyuria. Furthermore,r edistribution of retained fluid related to positional and hydrostatic changes may explain nocturnal increase in urine output, particularly as CKD becomes more advanced.

avoidance of caffeine and alcohol in the evening helps.

RIDGWAY, Alex, et al. Nocturia and chronic kidney disease: systematic review and nominal group technique consensus on primary care assessment and treatment. European Urology Focus, 2022, vol. 8, no 1, p. 18-25.

Melatonin can be considered a safe and effective treatment for nocturia [1, 2].

Nocturia is a manifestation of systemic diseases, in which chronic kidney disease (CKD) is an independent predictor of nocturia.

The presence of nocturia and heightened frequency of nocturnal urination have been found to be associated with a decline in eGFR.

SONG, Jianling; KE, Ben; FANG, Xiangdong. Association of nocturia of self-report with estimated glomerular filtration rate: a cross-sectional study from the NHANES 2005–2018. Scientific Reports, 2023, vol. 13, no 1, p. 13924.

Summary of behavioral and lifestyle management considerations for patients with nocturia

For nocturnal polyuria:

Evening fluid restriction (none for 2 hr prior to bedtime)

Total daily fluid restriction to 2 L/day, or reduce 25% from baseline

Reducing dietary salt intake

Reducing evening protein intake

Restriction/avoidance of caffeine and alcohol

Mobilizing peripheral edema fluid (evening leg elevation, support stockings).

For diminished bladder capacity :

Pre-emptive voiding or clean intermittent catheterization at bedtime

Pelvic floor muscle training

Bladder training

For Sleep disturbance:

Improving sleep hygiene (e.g., establishing a relaxing bedtime routine, minimizing electronics before bed)

Treatment of hot flashes in post-menopausal women.

For Multifactorial:

Management of chronic lifestyle-related diseases (e.g., diabetes, hypertension, cardiac disease).

Weight loss

Increasing exercise and fitness

NGUYEN, Laura N., et al. Canadian Urological Association best practice report: Diagnosis and management of nocturia. Canadian Urological Association Journal, 2022, vol. 16, no 7, p. E336.

Referencias 

1. BURKE, Christine Anh; NITTI, Victor W.; STOTHERS, Lynn. Melatonin and melatonin receptor agonists in the treatment of nocturia: A systematic review. Neurourology and Urodynamics, 2024, vol. 43, no 4, p. 826-839.

2. LEERASIRI, Pichai, et al. Effectiveness of melatonin for the treatment of nocturia: A randomized controlled trial. International Urogynecology Journal, 2023, vol. 34, no 2, p. 485-492.