The Relationship Between Nocturnal Polyuria and the Distribution of Body Fluid: Assessment by Bioelectric Impedance Analysis

Purpose

Increased nocturnal urinary volume is closely associated with nocturia. We investigated the relationship between nocturnal polyuria and the variation of body fluid distribution during the daytime using bioelectric impedance analysis.

Materials and Methods

A total of 34 men older than 60 years were enrolled in this study. A frequency volume chart was recorded. Nocturnal polyuria was defined as a nocturnal urine volume per 24-hour production of greater than 0.35 (the nocturnal polyuria index). Bioelectric impedance analysis was performed 4 times daily at 8 and 11 a.m., and 5 and 9 p.m. using an InBody S20 body composition analyzer (BioSpace, Seoul, Korea).

Results

A significant difference was found in mean ± SEM 24-hour urine production per fat-free mass between the groups with and without nocturnal polyuria (17.8 ± 1.4 vs 7.7 ± 0.9 ml/kg). The increase in fluid in the legs compared with the volume at 8 a.m. was significantly larger at 5 p.m., while there was no difference in the arms or trunk. Nocturnal urine volume significantly correlated with the difference in fluid volume in the legs (r = 0.527, p = 0.0019) and extracellular fluid volume (r = 0.3844, p = 0.0248) between the volumes at 8 a.m. and 9 p.m.

Conclusions

Overproduction of urine per fat-free mass leads to nocturnal polyuria. Extracellular fluid accumulates as edema in the legs during the day in patients with nocturnal polyuria. The volume of accumulated extracellular fluid correlates with nocturnal urine volume. We suggest that leg edema is the source of nocturnal urine volume and decreasing edema may cure nocturnal polyuria.

Key Words: urinary bladder, nocturia, circadian rhythm, extracellular fluid, electric impedance

Abbreviations and Acronyms: ANP, atrial natriuretic peptide, BIA, bioelectric impedance analysis, BNP, brain natriuretic peptide, Cr, creatinine, DSM, direct segmental multifrequency, ECF, extracellular fluid, FVC, frequency volume chart, ICF, intracellular fluid, NP, nocturnal polyuria, NPI, NP index, NUV, nocturnal urinary volume