title: Urinary incontinence and diuretic avoidance among adults with chronic kidney disease.
abstract: OBJECTIVE
  Diuretics remain an important medication for hypertension management among adults with chronic kidney disease (CKD), but diuretics may also worsen urinary symptoms, especially urinary incontinence (UI). This single-center pilot study examined the prevalence of UI among adults age ≥60 years with CKD using diuretics and assessed diuretic avoidance due to urinary symptoms.
  
  
  METHODS
  Patients with non-dialysis-dependent CKD (estimated glomerular filtration rate <60 ml/min/1.73 m(2)) and diuretic use were recruited from outpatient nephrology clinics. Urinary symptoms and diuretic avoidance were assessed using standardized questionnaires.
  
  
  RESULTS
  The cohort of 44 women and 54 men had a mean age of 71.8 (8.4) years, and urgency-UI, stress-UI and mixed-UI (the presence of both urgency-UI and stress-UI) were reported by 44.9 % (n = 44), 36.7 % (n = 36) and 26.5 % (n = 26), respectively. Nocturia was noted in 68 % (n = 67). Overall, 15.3 % (6 men and 9 women) reported diuretic avoidance. Avoidance of diuretics was 27.3 % (n = 12), 25.5 % (n = 9) and 34.6 % (n = 9) among participants with urgency-UI, stress-UI and mixed-UI, respectively, while only 6.8 % (n = 3) of participants without any UI reported diuretic avoidance. After adjusting for age, sex and diuretic type (loop vs. others), both urgency-UI (odds ratio 5.9 95 % CI 1.5-22.8) and mixed-UI (odds ratio 5.7; 95 % CI 1.6-19.9) were significantly associated with diuretic avoidance compared to participants without urgency-UI, or mixed-UI, respectively. Stress-UI and nocturia were not significantly associated with diuretic avoidance.
  
  
  CONCLUSIONS
  UI is common among older adults with CKD receiving diuretics. Patients with urgency-UI are more likely to avoid diuretics.
authors.affiliation: Division of Nephrology, Department of Medicine, Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA.
authors.forename: Mitul
authors.initials: M
authors.lastname: Patel
authors.affiliation: Division of Nephrology, Department of Medicine, Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA.
authors.forename: Kavitha
authors.initials: K
authors.lastname: Vellanki
authors.affiliation: Division of Nephrology, Department of Medicine, Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Leehey
authors.affiliation: Division of Nephrology, Department of Medicine, Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA.
authors.forename: Vinod K
authors.initials: VK
authors.lastname: Bansal
authors.affiliation: Department of Obstetrics and Gynecology, Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA.|Department of Urology, Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA.
authors.forename: Linda
authors.initials: L
authors.lastname: Brubaker
authors.affiliation: Department of Urology, Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Flanigan
authors.affiliation: Division of Nephrology, Department of Medicine, Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA.
authors.forename: Julia
authors.initials: J
authors.lastname: Koval
authors.affiliation: Division of Nephrology, Department of Medicine, Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA.
authors.forename: Anuradha
authors.initials: A
authors.lastname: Wadhwa
authors.affiliation: Clinical Research Office, Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA.
authors.forename: Neelam
authors.initials: N
authors.lastname: Balasubramanian
authors.affiliation: Clinical Research Office, Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA.
authors.forename: Jasmin
authors.initials: J
authors.lastname: Sandhu
authors.affiliation: Division of Nephrology, Department of Medicine, Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA. hkramer@luc.edu.|Department of Public Health Sciences, Loyola University Chicago, Stritch School of Medicine, CTRE Bldg 454, 2160 First Avenue, Maywood, IL, 60153, USA. hkramer@luc.edu.
authors.forename: Holly
authors.initials: H
authors.lastname: Kramer
mesh_terms: D017677:Age Distribution; D000368:Aged; D015331:Cohort Studies; D004232:Diuretics / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010865:Pilot Projects; D011379:Prognosis; D011788:Quality of Life; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D014549:Urinary Incontinence / Q000139:chemically induced* / Q000453:epidemiology* / Q000503:physiopathology
chemical_list: D004232:Diuretics
keywords: Chronic kidney disease; Diuretics; Incontinence; Nocturia; Urinary incontinence; Urinary symptoms