Spot Versus 24-Hour Urine Osmolality Measurement in Autosomal Dominant Polycystic Kidney Disease: A Diagnostic Test Study
Rationale & Objective: Arginine vasopressin (AVP) is an established driver of cyst growth in autosomal dominant polycystic kidney disease (ADPKD). Urine osmolality (osm) measures are surrogate markers of AVP activity. Both 24-hour and spot urine samples are used as indicators of AVP suppress...
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Elsevier
2025-03-01
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| Series: | Kidney Medicine |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2590059525000019 |
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| author | Ayub Akbari Sriram Sriperumbuduri Shreepryia Mangalgi Vijay Joshi Manish Sood Amos Buh Mohan Biyani Christopher McCudden Gregory L. Hundemer Pierre Antoine Brown |
| author_facet | Ayub Akbari Sriram Sriperumbuduri Shreepryia Mangalgi Vijay Joshi Manish Sood Amos Buh Mohan Biyani Christopher McCudden Gregory L. Hundemer Pierre Antoine Brown |
| author_sort | Ayub Akbari |
| collection | DOAJ |
| description | Rationale & Objective: Arginine vasopressin (AVP) is an established driver of cyst growth in autosomal dominant polycystic kidney disease (ADPKD). Urine osmolality (osm) measures are surrogate markers of AVP activity. Both 24-hour and spot urine samples are used as indicators of AVP suppression. The agreement between these 2 measurements remains unclear. Study Design: A retrospective cohort study. Setting & Study Population: Three hundred and forty-nine patients with ADPKD with 839 urine samples from a tertiary care center. Selection Criteria for Study: Patients with ADPKD with records of spot and 24-hour urine measurements. Data Extraction: Consecutive patients’ data from January 2018 to March 2023 were extracted from the quality assurance database of The Ottawa Hospital Cystic Kidney Disease Clinic. Analytical Approach: Discordance assessed at target urine osmolality of 250 and 270 mmol/kg. Agreement assessed by Bland-Altman plots. The percentage of patients with difference in osmolality between the 2 measures for cutoff points of > 50, > 100, >150, and > 200 mmol/kg was calculated. Results: The mean 24-hour urine osm was 364 mmol/kg, and the mean spot urine osm was 424 mosm/kg. Mean age of 46 years, 52% females, and 47 (13.5%) were on tolvaptan. Overall, in comparing spot urine osm to 24-hour urine osm, the discordance at 250 and 270 mmol/kg was 24% with poor agreement on Bland-Altman plots. The differences between the 2 measures at varying cutoff points were 53.9% at 50 mmol/kg, 35.8% at 100 mmol/kg, 24.1% at 150 mmol/kg, and 16.1% at 200 mmol/kg. Results were similar when only a single measurement from each patient was used for analysis. Limitations: Total of 29% of patients did not have concurrent spot urine osmolality and 24-hour urine osmolality. The study was conducted at a single center. Limited number of patients were on tolvaptan. Conclusions: In adults with ADPKD, important differences exist between the 24-hour urine osmolality and spot urine osmolality that preclude interchangeable use. The method employed may impact clinical decision-making. More research is needed to determine, which urine osm should be used when assessing AVP suppression. Plain Language Summary: Urine osmolality measures are used clinically to dose tolvaptan in patients with adult polycystic kidney disease. We compared urine osmolality from 24-hour and spot urine samples. We found out that important differences exist between 24-hour and spot urine samples’ osmolality. The method employed to determine urine osmolality may impact clinical decision-making in the management of patients with adult polycystic kidney disease. |
| format | Article |
| id | doaj-art-07f961476e444cb6ac8f6a225bcd1624 |
| institution | Kabale University |
| issn | 2590-0595 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Elsevier |
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| series | Kidney Medicine |
| spelling | doaj-art-07f961476e444cb6ac8f6a225bcd16242025-02-04T04:10:32ZengElsevierKidney Medicine2590-05952025-03-0173100965Spot Versus 24-Hour Urine Osmolality Measurement in Autosomal Dominant Polycystic Kidney Disease: A Diagnostic Test StudyAyub Akbari0Sriram Sriperumbuduri1Shreepryia Mangalgi2Vijay Joshi3Manish Sood4Amos Buh5Mohan Biyani6Christopher McCudden7Gregory L. Hundemer8Pierre Antoine Brown9Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Kidney Research Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, CanadaDepartment of Medicine, University of Mississippi Medical Centre, Jackson, MSDepartment of Medicine, University of Missouri Health Centre, Columbia, MODepartment of Medicine, University of Missouri Health Centre, Columbia, MODivision of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Kidney Research Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, CanadaKidney Research Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, CanadaDivision of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Kidney Research Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, CanadaDepartment of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Ontario, CanadaDivision of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Kidney Research Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, CanadaDivision of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Kidney Research Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Address for Correspondence: Pierre Antoine Brown, MD, MSc, Division of Nephrology, The Ottawa Hospital, 1967 Riverside Dr, Ottawa, Ontario, Canada, K1H 7W9.Rationale & Objective: Arginine vasopressin (AVP) is an established driver of cyst growth in autosomal dominant polycystic kidney disease (ADPKD). Urine osmolality (osm) measures are surrogate markers of AVP activity. Both 24-hour and spot urine samples are used as indicators of AVP suppression. The agreement between these 2 measurements remains unclear. Study Design: A retrospective cohort study. Setting & Study Population: Three hundred and forty-nine patients with ADPKD with 839 urine samples from a tertiary care center. Selection Criteria for Study: Patients with ADPKD with records of spot and 24-hour urine measurements. Data Extraction: Consecutive patients’ data from January 2018 to March 2023 were extracted from the quality assurance database of The Ottawa Hospital Cystic Kidney Disease Clinic. Analytical Approach: Discordance assessed at target urine osmolality of 250 and 270 mmol/kg. Agreement assessed by Bland-Altman plots. The percentage of patients with difference in osmolality between the 2 measures for cutoff points of > 50, > 100, >150, and > 200 mmol/kg was calculated. Results: The mean 24-hour urine osm was 364 mmol/kg, and the mean spot urine osm was 424 mosm/kg. Mean age of 46 years, 52% females, and 47 (13.5%) were on tolvaptan. Overall, in comparing spot urine osm to 24-hour urine osm, the discordance at 250 and 270 mmol/kg was 24% with poor agreement on Bland-Altman plots. The differences between the 2 measures at varying cutoff points were 53.9% at 50 mmol/kg, 35.8% at 100 mmol/kg, 24.1% at 150 mmol/kg, and 16.1% at 200 mmol/kg. Results were similar when only a single measurement from each patient was used for analysis. Limitations: Total of 29% of patients did not have concurrent spot urine osmolality and 24-hour urine osmolality. The study was conducted at a single center. Limited number of patients were on tolvaptan. Conclusions: In adults with ADPKD, important differences exist between the 24-hour urine osmolality and spot urine osmolality that preclude interchangeable use. The method employed may impact clinical decision-making. More research is needed to determine, which urine osm should be used when assessing AVP suppression. Plain Language Summary: Urine osmolality measures are used clinically to dose tolvaptan in patients with adult polycystic kidney disease. We compared urine osmolality from 24-hour and spot urine samples. We found out that important differences exist between 24-hour and spot urine samples’ osmolality. The method employed to determine urine osmolality may impact clinical decision-making in the management of patients with adult polycystic kidney disease.http://www.sciencedirect.com/science/article/pii/S2590059525000019Urine osmolarityspot and 24-hour measurementautosomal dominant polycystic kidney disease |
| spellingShingle | Ayub Akbari Sriram Sriperumbuduri Shreepryia Mangalgi Vijay Joshi Manish Sood Amos Buh Mohan Biyani Christopher McCudden Gregory L. Hundemer Pierre Antoine Brown Spot Versus 24-Hour Urine Osmolality Measurement in Autosomal Dominant Polycystic Kidney Disease: A Diagnostic Test Study Kidney Medicine Urine osmolarity spot and 24-hour measurement autosomal dominant polycystic kidney disease |
| title | Spot Versus 24-Hour Urine Osmolality Measurement in Autosomal Dominant Polycystic Kidney Disease: A Diagnostic Test Study |
| title_full | Spot Versus 24-Hour Urine Osmolality Measurement in Autosomal Dominant Polycystic Kidney Disease: A Diagnostic Test Study |
| title_fullStr | Spot Versus 24-Hour Urine Osmolality Measurement in Autosomal Dominant Polycystic Kidney Disease: A Diagnostic Test Study |
| title_full_unstemmed | Spot Versus 24-Hour Urine Osmolality Measurement in Autosomal Dominant Polycystic Kidney Disease: A Diagnostic Test Study |
| title_short | Spot Versus 24-Hour Urine Osmolality Measurement in Autosomal Dominant Polycystic Kidney Disease: A Diagnostic Test Study |
| title_sort | spot versus 24 hour urine osmolality measurement in autosomal dominant polycystic kidney disease a diagnostic test study |
| topic | Urine osmolarity spot and 24-hour measurement autosomal dominant polycystic kidney disease |
| url | http://www.sciencedirect.com/science/article/pii/S2590059525000019 |
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