title: Optimizing response to desmopressin in patients with monosymptomatic nocturnal enuresis.
abstract: Most patients with monosymptomatic nocturnal enuresis can be effectively treated with an enuresis alarm or antidiuretic therapy (desmopressin), depending on the pathophysiology of the condition in the individual patient. Desmopressin is first-line therapy for enuresis caused by nocturnal polyuria, an excessive urine output during the night. However, in a recent study, around one-third of patients thought to be resistant to desmopressin were subsequently treated effectively with desmopressin monotherapy in a specialist centre. The aim of this article is to review best practice in selecting patients for desmopressin treatment, as well as outline eight recommendations for maximizing the chances of treatment success in patients receiving desmopressin. The roles of formulation, dose, timing of administration, food and fluid intake, inter-individual variation in response, body weight, adherence, withdrawal strategies and combination therapies are discussed in light of the most recent research on desmopressin and enuresis. Possible reasons for suboptimal treatment response are explored and strategies to improve outcomes in patients for whom desmopressin is an appropriate therapy are presented. Through optimization of the treatment plan in primary and specialist care centres, the hope is that fewer patients with this distressing and often embarrassing condition will experience unnecessary delays in receiving appropriate care and achieving improvements.
authors.affiliation: Department of Pediatrics, Aarhus University Hospital, Skejby, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark. konskamp@rm.dk.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Kamperis
authors.affiliation: Department of Pediatric Nephrology, University Hospital Ghent, Ghent, Belgium.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Van Herzeele
authors.affiliation: Department of Pediatrics, Aarhus University Hospital, Skejby, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.|University of Ghent, Ghent, Belgium.
authors.forename: Soren
authors.initials: S
authors.lastname: Rittig
authors.affiliation: Department of Pediatric Nephrology, Safepedrug Consortium, University Hospital Ghent, Ghent, Belgium.
authors.forename: Johan
authors.initials: J
authors.lastname: Vande Walle
mesh_terms: D050034:Antidiuretic Agents / Q000008:administration & dosage*; D002648:Child; D003894:Deamino Arginine Vasopressin / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D053206:Nocturnal Enuresis / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D050034:Antidiuretic Agents; D003894:Deamino Arginine Vasopressin
keywords: Best practices; Desmopressin; Nocturnal enuresis; Treatment outcome; Treatment resistance