PMID- 27225436 OWN - NLM STAT- MEDLINE DCOM- 20170504 LR - 20230318 IS - 1938-3207 (Electronic) IS - 0002-9165 (Linking) VI - 104 IP - 1 DP - 2016 Jul TI - Water-loss (intracellular) dehydration assessed using urinary tests: how well do they work? Diagnostic accuracy in older people. PG - 121-31 LID - 10.3945/ajcn.115.119925 [doi] AB - BACKGROUND: Water-loss dehydration (hypertonic, hyperosmotic, or intracellular dehydration) is due to insufficient fluid intake and is distinct from hypovolemia due to excess fluid losses. Water-loss dehydration is associated with poor health outcomes such as disability and mortality in older people. Urine specific gravity (USG), urine color, and urine osmolality have been widely advocated for screening for dehydration in older adults. OBJECTIVE: We assessed the diagnostic accuracy of urinary measures to screen for water-loss dehydration in older people. DESIGN: This was a diagnostic accuracy study of people aged >/=65 y taking part in the DRIE (Dehydration Recognition In our Elders; living in long-term care) or NU-AGE (Dietary Strategies for Healthy Ageing in Europe; living in the community) studies. The reference standard was serum osmolality, and index tests included USG, urine color, urine osmolality, urine cloudiness, additional dipstick measures, ability to provide a urine sample, and the volume of a random urine sample. Minimum useful diagnostic accuracy was set at sensitivity and specificity >/=70% or a receiver operating characteristic plot area under the curve >/=0.70. RESULTS: DRIE participants (women: 67%; mean age: 86 y; n = 162) had more limited cognitive and functional abilities than did NU-AGE participants (women: 64%; mean age: 70 y; n = 151). Nineteen percent of DRIE participants and 22% of NU-AGE participants were dehydrated (serum osmolality >300 mOsm/kg). Neither USG nor any other potential urinary tests were usefully diagnostic for water-loss dehydration. CONCLUSIONS: Although USG, urine color, and urinary osmolality have been widely advocated for screening for dehydration in older adults, we show, in the largest study to date to our knowledge, that their diagnostic accuracy is too low to be useful, and these measures should not be used to indicate hydration status in older people (either alone or as part of a wider tranche of tests). There is a need to develop simple, inexpensive, and noninvasive tools for the assessment of dehydration in older people. The DRIE study was registered at www.researchregister.org.uk as 122273. The NU-AGE trial was registered at clinicialtrials.gov as NCT01754012. CI - (c) 2016 American Society for Nutrition. FAU - Hooper, Lee AU - Hooper L AUID- ORCID: 0000-0002-7904-3331 AD - Norwich Medical School, University of East Anglia, Norwich, United Kingdom; and l.hooper@uea.ac.uk. FAU - Bunn, Diane K AU - Bunn DK AUID- ORCID: 0000-0002-7809-7100 AD - Norwich Medical School, University of East Anglia, Norwich, United Kingdom; and. FAU - Abdelhamid, Asmaa AU - Abdelhamid A AUID- ORCID: 0000-0002-9897-5433 AD - Norwich Medical School, University of East Anglia, Norwich, United Kingdom; and. FAU - Gillings, Rachel AU - Gillings R AD - Norwich Medical School, University of East Anglia, Norwich, United Kingdom; and. FAU - Jennings, Amy AU - Jennings A AD - Norwich Medical School, University of East Anglia, Norwich, United Kingdom; and. FAU - Maas, Katie AU - Maas K AD - Norwich Medical School, University of East Anglia, Norwich, United Kingdom; and. FAU - Millar, Sophie AU - Millar S AD - School of Agriculture and Food Science, University College Dublin, Dublin, Ireland. FAU - Twomlow, Elizabeth AU - Twomlow E AD - Norwich Medical School, University of East Anglia, Norwich, United Kingdom; and. FAU - Hunter, Paul R AU - Hunter PR AD - Norwich Medical School, University of East Anglia, Norwich, United Kingdom; and. FAU - Shepstone, Lee AU - Shepstone L AD - Norwich Medical School, University of East Anglia, Norwich, United Kingdom; and. FAU - Potter, John F AU - Potter JF AD - Norwich Medical School, University of East Anglia, Norwich, United Kingdom; and. FAU - Fairweather-Tait, Susan J AU - Fairweather-Tait SJ AUID- ORCID: 0000-0002-1413-5569 AD - Norwich Medical School, University of East Anglia, Norwich, United Kingdom; and. LA - eng SI - ClinicalTrials.gov/NCT01754012 GR - CDF-2011-04-025/DH_/Department of Health/United Kingdom PT - Journal Article PT - Randomized Controlled Trial PT - Validation Study DEP - 20160525 PL - United States TA - Am J Clin Nutr JT - The American journal of clinical nutrition JID - 0376027 RN - 0 (Biomarkers) RN - 059QF0KO0R (Water) SB - IM CIN - Am J Clin Nutr. 2016 Jul;104(1):3-4. PMID: 27305951 MH - Aged MH - Aged, 80 and over MH - Area Under Curve MH - Biomarkers/urine MH - Color MH - Dehydration/*diagnosis/urine MH - Female MH - Humans MH - Male MH - Osmolar Concentration MH - ROC Curve MH - Sensitivity and Specificity MH - Specific Gravity MH - Urinalysis/*methods MH - *Water MH - *Water-Electrolyte Balance OTO - NOTNLM OT - aged OT - dehydration OT - osmolar concentration OT - sensitivity and specificity OT - specific gravity OT - urinalysis EDAT- 2016/05/27 06:00 MHDA- 2017/05/05 06:00 CRDT- 2016/05/27 06:00 PHST- 2015/07/23 00:00 [received] PHST- 2016/04/06 00:00 [accepted] PHST- 2016/05/27 06:00 [entrez] PHST- 2016/05/27 06:00 [pubmed] PHST- 2017/05/05 06:00 [medline] AID - S0002-9165(22)04517-8 [pii] AID - 10.3945/ajcn.115.119925 [doi] PST - ppublish SO - Am J Clin Nutr. 2016 Jul;104(1):121-31. doi: 10.3945/ajcn.115.119925. Epub 2016 May 25.