背景:肾功能降低会损害盐和水的稳态,可以驱动夜间或24小时多尿。夜尿症可以在慢性肾脏疾病(CKD)的早期出现。基于证据的建议可以促进肾病诊所以外的管理。
目的:对CKD患者的夜尿症进行系统评价(SR),并就肾脏病以外的初级保健和专科诊所的管理达成专家共识。
方法:从2000年1月至2020年4月检索了四个数据库。共筛选了4011篇标题和摘要,108项研究进行了全文筛选。七项研究符合纳入标准,两项通过其他来源确定。使用名义小组技术(NGT)在公众参与的专家小组之间达成了共识。
结果:一些可能的机制导致CKD患者夜间或24小时多尿,但是关于改善夜尿症的干预措施的证据很少。对于CKD患者或在非肾脏病环境中评估有CKD风险的患者的夜尿症(每晚至少两次空洞)的NGT评估建议是:病史(口渴,液体摄入量),药物审查(利尿剂,锂,钙通道拮抗剂,非甾体抗炎药),检查(水肿状态,血压),尿液分析(血尿和白蛋白/肌酐比率),血液检查(血尿素,血清肌酐和电解质,估计的肾小球滤过率),还有膀胱日记.肾脏超声检查应遵循当地CKD指南。治疗方案包括优化血压控制,饮食调整,以减少盐的摄入量,流体建议,和药物审查。转诊专科肾脏病服务应遵循当地指南。
结论:在评估夜尿症患者时,应考虑CKD。评估的目的是确定机制和鼓励治疗,但后者可能比夜尿症本身更适用于降低与CKD相关的更广泛的发病率。
结果:患有肾脏疾病的人可能会因为需要通尿过夜而遭受严重的睡眠障碍。我们查看了已发表的研究,发现了一些有关潜在机制的有用信息。一组专家能够开发评估和治疗这种情况的实用方法。
BACKGROUND: 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.
METHODS: 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).
RESULTS: 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.
RESULTS: 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.