Water-loss (intracellular) dehydration assessed using urinary tests: How well do they work? Diagnostic accuracy in older people

American Journal of Clinical Nutrition

Volumn 104, Issue 1, 2016, Pages 121-131

  Hooper, Lee ^a   Bunn, Diane K ^a   Abdelhamid, Asmaa ^a   Gillings, Rachel ^a   Jennings, Amy ^a   Maas, Katie ^a   Millar, Sophie ^b   Twomlow, Elizabeth ^a   Hunter, Paul R ^a   Shepstone, Lee ^a   Potter, John F ^a   Fairweather Tait, Susan J ^a  

^a UNIVERSITY OF EAST ANGLIA   (United Kingdom)

^b UNIVERSITY COLLEGE DUBLIN   (Ireland)

Author keywords

Aged; Dehydration; Osmolar concentration; Sensitivity and specificity; Specific gravity; Urinalysis

Indexed keywords

AGED; ARTICLE; COGNITIVE DEFECT; CONTROLLED CLINICAL TRIAL (TOPIC); CONTROLLED STUDY; DEHYDRATION; DIAGNOSTIC ACCURACY; DIAGNOSTIC TEST ACCURACY STUDY; FEMALE; FUNCTIONAL DISEASE; GERIATRIC PATIENT; HUMAN; MAJOR CLINICAL STUDY; MALE; RECEIVER OPERATING CHARACTERISTIC; RENAL SYSTEM PARAMETERS; SCREENING; SENSITIVITY AND SPECIFICITY; SERUM OSMOLALITY; URINALYSIS; URINE CLOUDINESS; URINE COLOR; URINE OSMOLALITY; URINE VOLUME; WATER LOSS DEHYDRATION; AREA UNDER THE CURVE; COLOR; ELECTROLYTE BALANCE; OSMOLARITY; PROCEDURES; RANDOMIZED CONTROLLED TRIAL; RELATIVE DENSITY; URINE; VALIDATION STUDY; VERY ELDERLY;

BIOLOGICAL MARKER; WATER;

AGED; AGED, 80 AND OVER; AREA UNDER CURVE; BIOMARKERS; COLOR; DEHYDRATION; FEMALE; HUMANS; MALE; OSMOLAR CONCENTRATION; ROC CURVE; SENSITIVITY AND SPECIFICITY; SPECIFIC GRAVITY; URINALYSIS; WATER; WATER-ELECTROLYTE BALANCE;

EID: 84977073573     PISSN: 00029165     EISSN: 19383207     Source Type: Journal    
DOI: 10.3945/ajcn.115.119925     Document Type: Article

References (75)

1. Thomas DR, Cote TR, Lawhorne L, Levenson SA, Rubenstein LZ, Smith DA, Stefanacci RG, Tangalos EG, Morley JE, Dehydration Council. Understanding clinical dehydration and its treatment. J Am Med Dir Assoc 2008;9:292-301.
2. Cheuvront SN, Kenefick RW. Dehydration: physiology, assessment, and performance effects. Compr Physiol 2014;4:257-85.
3. Hooper L, Bunn D, Jimoh FO, Fairweather-Tait SJ. Water-loss dehydration and aging. Mech Ageing Dev 2014;136-7:50-8.
4. Mange K, Matsuura D, Cizman B, Solo H, Ziyadeh FN, Goldfarb S, Neilson EG. Language guiding therapy: the case of dehydration versus volume depletion. Ann Intern Med 1997;127:848-53.
5. Stookey JD, Purser JL, Pieper CF, Cohen HJ. Plasma hypertonicity: Another marker of frailty? J Am Geriatr Soc 2004;52:1313-20.
6. El-Sharkawy AM, Watson P, Neal KR, Ljungqvist O, Maughan RJ, Sahota O, Lobo DN. Hydration and outcome in older patients admitted to hospital (The HOOP prospective cohort study). Age Ageing 2015;44:943-7.
7. Bhalla A, Sankaralingam S, Dundas R, Swaminathan R, Wolfe CD, Rudd AG. Influence of raised plasma osmolality on clinical outcome after acute stroke. Stroke 2000;31:2043-8.
8. Siervo M, Bunn D, Prado C, Hooper L. Accuracy of prediction equations for serum osmolarity in frail older people with and without diabetes. Am J Clin Nutr 2014;100:867-76.
9. Institute of Medicine, Panel on Dietary Reference Intakes for Electrolytes and Water. Dietary Reference Intakes for water, potassium, sodium, chloride, and sulfate. Washington (DC): National Academies Press; 2004.
10. Cheuvront SN, Kenefick RW, Charkoudian N, Sawka MN. Physiologic basis for understanding quantitative dehydration assessment. Am J Clin Nutr 2013;97:455-62.
11. Shirreffs SM. Markers of hydration status. Eur J Clin Nutr 2003;57:S6-9.
12. Cheuvront SN, Ely BR, Kenefick RW, Sawka MN. Biological variation and diagnostic accuracy of dehydration assessment markers. Am J Clin Nutr 2010;92:565-73.
13. Vivanti A, Yu L, Palmer M, Dakin L, Sun J, Campbell K. Short-term body weight fluctuations in older well-hydrated hospitalised patients. J Hum Nutr Diet 2013;26:429-35.
14. Hooper L, Bunn DK, Downing A, Jimoh FO, Groves J, Free C, Cowap V, Potter JF, Hunter PR, Shepstone L. Which frail older people are dehydrated? The UK DRIE study. J Gerontol A Biol Sci Med Sci 2015 Nov 9 (Epub ahead of print; DOI: 10.1093/gerona/glv205).
15. Jimoh FO, Bunn D, Hooper L. Assessment of a self-reported drinks diary for the estimation of drinks intake by care home residents: Fluid Intake Study in the Elderly (FISE). J Nutr Health Aging 2015;19:491-6.
16. Gandy J. Water intake: validity of population assessment and recommendations. Eur J Nutr 2015;54:11-6.
17. Thomas DR, Tariq SH, Makhdomm S, Haddad R, Moinuddin A. Physician misdiagnosis of dehydration in older adults. J Am Med Dir Assoc 2003;4:251-4.
18. Leibovitz A, Baumoehl Y, Lubart E, Yaina A, Platinovitz N, Segal R. Dehydration among long-term care elderly patients with oropharyngeal dysphagia. Gerontology 2007;53:179-83.
19. Mentes J. Managing oral hydration. In:Boltz M, Capezuti E, Fulmer T, Zwicker D, editors. Evidence-based geriatric nursing protocols for best practice. 4th ed. New York: Springer Publishing Company; 2012. p. 419-38.
20. Wotton K, Crannitch K, Munt R. Prevalence, risk factors and strategies to prevent dehydration in older adults. Contemp Nurse 2008;31:44-56.
21. Dougherty L, Lister S. The Royal Marsden Hospital manual of clinical nursing procedures. Oxford (United Kingdom): Wiley-Blackwell; 2011.
22. Woodward M. Guidelines to effective hydration in aged care facilities [Internet]. Version current April 2013 [cited 2015 Jul 6]. Available from: http://www.hydralyte.ca/wp-content/uploads/2014/07/HBR9-0413-Hydration-in-aged-care-facilities-12pp-V2pdf 2013.
23. Kavouras SA. Assessing hydration status. Curr Opin Clin Nutr Metab Care 2002;5:519-24.
24. Armstrong LE. Assessing hydration status: the elusive gold standard. J Am Coll Nutr 2007;26:575S-84S.
25. Armstrong LE, Maresh C, Castellani J, Bergeron MF, Kenefick RW, LaGasse KE, Riebe D. Urinary indices of hydration status. Int J Sport Nutr 1994;4:265-79.
26. Docherty B. Physical assessment of hydration. Nurs Times 2008;104:9.
27. Begum MN, Johnson CS. A review of the literature on dehydration in the institutionalized elderly. e-SPEN 2010;5:e47-53.
28. Bryant H. Dehydration in older people: assessment and management. Emerg Nurse 2007;15:22-6.
29. Grandjean AC, Reimers KJ, Buyckx ME. Hydration: issues for the 21st century. Nutr Rev 2003;61:261-71.
30. Lima Ribeiro SM, Morley JE. Dehydration is difficult to detect and prevent in nursing homes. J Am Med Dir Assoc 2015;16:175-6.
31. NHS Choices. Dehydration - symptoms [Internet]. 2015 [cited 2015 Mar 15]. Available from: http://www.nhs.uk/Conditions/Dehydration/Pages/Symptoms aspx 2015.
32. Lapides J, Bourne RB, Maclean LR. Clinical signs of dehydration and extracellular fluid loss. JAMA 1965;191:413-5.
33. Perrier E, Vergne S, Klein A, Poupin M, Rondeau P, LeBellego L, Armstrong LE, Lang F, Stookey JD, Tack I. Hydration biomarkers in free-living adults with different levels of habitual fluid consumption. Br J Nutr 2013;109:1678-87.
34. Cheuvront SN, Sawka MN. Hydration assessment of athletes. Sports Science Exchange 2005;18:1-12.
35. Shirreffs SM, Merson SJ, Fraser SM, Archer DT. The effects of fluid restriction on hydration status and subjective feelings in man. Br J Nutr 2004;91:951-8.
36. McKenzie AL, Munoz CX, Armstrong LE. Accuracy of urine color to detect equal to or greater than 2% body mass loss in men. J Athl Train 2015;50:1306-9.
37. Vivanti A, Harvey K, Ash S, Battistutta D. Clinical assessment of dehydration in older people admitted to hospital: what are the strongest indicators? Arch Gerontol Geriatr 2008;47:340-55.
38. Rowat A, Smith L, Graham C, Lyle D, Horsburgh D, Dennis M. A pilot study to assess if urine specific gravity and urine colour charts are useful indicators of dehdyration in acute stroke patients. J Adv Nurs 2011;67:1976-83.
39. Shimizu M, Kinoshita K, Hattori K, Ota Y, Kanai T, Kobayashi H, Tokuda Y. Physical signs of dehydration in the elderly. Intern Med 2012;51:1207-10.
40. Rathnayake T. Dehydration: assessment. Adelaide (Australian): University of Adelaide, Joanna Briggs Institute; 2013.
41. American Medical Directors Association (AMDA). Dehydration and fluid maintenance in the long-term care setting. Columbia (MD): American Medical Directors Association (AMDA); 2009.
42. Mentes JC, Wakefield B, Culp KR. Use of a urine color chart to monitor hydration status in nursing home residents. Biol Res Nurs 2006;7:197-203.
43. Wakefield B, Mentes J, Diggelmann L, Culp K. Monitoring hydration status in elderly veterans. West J Nurs Res 2002;24:132-42.
44. Fortes MB, Raymond-Barker P, Bishop C, Elghenzai S, Oliver SJ, Walsh NP. Is this elderly patient dehydrated? Diagnostic accuracy of hydration assessment using physical signs, urine, and saliva markers. J Am Med Dir Assoc 2015;16:221-8.
45. Hooper L, Bunn D. DRIE - dehydration recognition in our elders [Internet]. 2014 [cited 2015 Sep 20]. Available from: http://driestudyappspot.com/.
46. Stuempfle KJ, Drury DG. Comparison of 3 methods to assess urine specific gravity in collegiate wrestlers. J Athl Train 2003;38:315-9.
47. Mahoney FI, Barthel D. Functional evaluation: the Barthel Index. Md State Med J 1965;14:61-5.
48. Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-98.
49. Santoro A, Pini A, Scurti M, Palmas G, Berendsen A, Brzozowska A, Pietruszka B, Szczecinska A, Cano N, Meunier N, et al. Combating inflammaging through a Mediterranean whole diet approach: the NU-AGE project's conceptual framework and design. Mech Ageing Dev 2014;136-7:3-13.
50. Berendsen A, Santoro A, Pini A, Cevenini E, Ostan R, Pietruszka B, Rolf K, Cano N, Caille A, Lyon-Belgy N, et al. A parallel randomized trial on the effect of a healthful diet on inflammageing and its consequences in European elderly people: design of the NU-AGE dietary intervention study. Mech Ageing Dev 2013;134:523-30.
51. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001;56:M146-56.
52. Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychosocial function. JAMA 1963;185:914-9.
53. Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 1969;9:179-86.
54. Bossuyt PM, Reitsma JB, Bruns DE, Gastonis PP, Glasziou PP, Irwig LM, Lijmer JG, Moher D, Rennie D, de Vet HC, et al. Toward complete and accurate reporting of studies of diagnostic accuracy: the STARD initiative. BMJ 2003;326:41-4.
55. Schreier C, Kremer W, Huber F, Neumann S, Pagel P, Kienemann K, Pestel S, numares GROUP. Reproducibility of NMR analysis of urine samples?: impact of sample preparation, storage conditions, and animal health status. BioMed Research International 2013;2013:ID 878374.
56. Van Berkel E, Schel O, Boer K. Influence of the storage temperature on urine analysis in timed samples. Ned Tijdschr voor Klin Chemie en Lab 2010;35:173-4.
57. Cheuvront SN, Kenefick RW, Charkoudian N, Sawka MN. Reply to LE Armstrong et al. Am J Clin Nutr 2013;98:505-6.
58. Armstrong LE, Maughan RJ, Senay LC, Shirreffs SM. Limitations to the use of plasma osmolality as a hydration marker. Am J Clin Nutr 2013;98:503-4.
59. Sterns RH, Spital A. Disorders of water balance. In:Kokko JP, Tannen RL, editors. Fluids and electrolytes. 2nd ed. Philadelphia: WB Saunders Company; 1990. p. 139-94.
60. Son SJ, Filosa JA, Potapenko ES, Biancardi VC, Zheng H, Patel KP, Tobin VA, Ludwig M, Stern JE. Dendritic peptide release mediates interpopulation crosstalk between neurosecretory and preautonomic networks. Neuron 2013;78:1036-49.
61. Bunn D, Jimoh FO, Howard Wilsher S, Hooper L. Increasing fluid intake and reducing dehydration risk in older people living in long-term care: a systematic review. J Am Med Dir Assoc 2015;16:101-13.
62. Hooper L, Abdelhamid A, Atreed NJ, Campbell WW, Chassagne P, Channell AM, Culp KR, Fletcher SJ, Fortes MB, Fuller N, et al. Clinical symptoms, signs and tests for identification of impending and current water-loss dehydration in older people. Cochrane Database Syst Rev 2015;2015:CD009647.
63. Bossingham MJ, Carnell NS, Campbell WW. Water balance, hydration status, and fat-free mass hydration in younger and older adults. Am J Clin Nutr 2005;81:1342-50.
64. Sjöstrand F, Rodhe P, Berglund E, Lundstrom N, Svensen C. The use of a noninvasive hemoglobin monitor for volume kinetic analysis in an emergency room setting. Anesth Analg 2013;116:337-42.
65. Fletcher SJ, Slaymaker AE, Bodenham AR, Vucevic M, Fletcher SJ, Slaymaker AE, Bodenham AR, Vucevic M. Urine colour as an index of hydration in critically ill patients. Anaesthesia 1999;54:189-92.
66. Johnson TM, Miller M, Pillion DJ, Ouslander JG. Arginine vasopressin and nocturnal polyuria in older adults with frequent nighttime voiding. J Urol 2003;170:480-4.
67. Lindner G, Kneidinger N, Holzinger U, Druml W, Schwarz C, Lindner G, Kneidinger N, Holzinger U, Druml W, Schwarz C. Tonicity balance in patients with hypernatremia acquired in the intensive care unit. Am J Kidney Dis 2009;54:674-9.
68. Culp K, Mentes J, Wakefield B, Culp K, Mentes J, Wakefield B. Hydration and acute confusion in long-term care residents. West J Nurs Res 2003;25:251-66.
69. Powers JS, Choi L, Bitting R, Gupta N, Buchowski M, Powers JS, Choi L, Bitting R, Gupta N, Buchowski M. Rapid measurement of total body water to facilitate clinical decision making in hospitalized elderly patients. J Gerontol A Biol Sci Med Sci 2009;64:664-9.
70. Arai S, Stotts N, Puntillo K. Thirst in critically ill patients: from physiology to sensation. Am J Crit Care 2013;22:328-35.
71. Davies DF, Shock NW. Age changes in glomerular filtration rate, effective renal plasma flow, and tubular excretory capacity in adult males. J Clin Invest 1950;29:496-507.
72. Rowe JW, Shock NW, Defronzo RA. The influence of age on the renal response to water deprivation in man. Nephron 1976;17:270-8.
73. Davies I, O'Neill PA, McLean KA, Catania J, Bennett D. Age-associated alterations in thirst and arginine vasopressin in response to a water or sodium load. Age Ageing 1995;24:151-9.
74. Lindeman RD, Tobin JN, Shock NW. Longitudinal studies on the rate of decline in renal function with age. J Am Geriatr Soc 1985;33:278-85.
75. Hooper L, Abdelhamid A, Ali A, Bunn DK, Jennings A, John G, Kerry S, Lindner G, Pfortmüller CA, Sjöstrand F, et al. Diagnostic accuracy of calculated serum osmolarity to predict dehydration in older people: adding value to pathology lab reports. BMJ Open 2015;5:e008846.