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To hydrate or not to hydrate? The effect of hydration on survival, symptoms and quality of dying among terminally ill cancer patients.
Wu, CY, Chen, PJ, Ho, TL, Lin, WY, Cheng, SY
BMC palliative care. 2021;(1):13
Abstract
BACKGROUND Artificial nutrition and hydration do not prolong survival or improve clinical symptoms of terminally ill cancer patients. Nonetheless, little is known about the effect of artificial hydration (AH) alone on patients' survival, symptoms or quality of dying. This study explored the relationship between AH and survival, symptoms and quality of dying among terminally ill cancer patients. METHODS A pilot prospective, observational study was conducted in the palliative care units of three tertiary hospitals in Taiwan between October 2016 and December 2017. A total of 100 patients were included and classified into the hydration and non-hydration group using 400 mL of fluid per day as the cut-off point. The quality of dying was measured by the Good Death Scale (GDS). Multivariate analyses using Cox's proportional hazards model were used to assess the survival status of patients, the Wilcoxon rank-sum test for within-group analyses and the Mann-Whitney U test for between-groups analyses to evaluate changes in symptoms between day 0 and 7 in both groups. Logistic regression analysis was used to assess the predictors of a good death. RESULTS There were no differences in survival (p = 0.337) or symptom improvement between the hydration and non-hydration group, however, patients with AH had higher GDS scores. CONCLUSIONS AH did not prolong survival nor significantly improve dehydration symptoms of terminally ill cancer patients but it may influence the quality of dying. Communication with patients and their families on the effect of AH may help them better prepared for the end-of-life experience.
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2.
Short sleep duration is associated with inadequate hydration: cross-cultural evidence from US and Chinese adults.
Rosinger, AY, Chang, AM, Buxton, OM, Li, J, Wu, S, Gao, X
Sleep. 2019;(2)
Abstract
STUDY OBJECTIVES Short and long sleep durations are linked to reduced kidney function, but little research has examined how sleep is associated with hydration status. Our aim was to assess the relationship between sleep duration and urinary hydration biomarkers among adults in a cross-cultural context. METHODS Three samples of adults aged ≥20 years were analyzed: 2007-2008 National Health and Nutrition Examination Survey (NHANES; n = 4680), 2009-2012 NHANES (n = 9559), and 2012 cross-sectional wave of the Chinese Kailuan Study (n = 11903), excluding pregnant women and adults with failing kidneys. We estimated multiple linear regression models between self-reported usual night-time sleep duration (<6, 6, 7, 8 (reference), and ≥9 hr/day) and urine specific gravity (Usg) and urine osmolality (Uosm) as continuous variables and logistic regression models dichotomized as inadequate hydration (>1.020 g/mL; >831 mOsm/kg). In primary analyses, we estimated models excluding diabetes and diuretic medications for healthier subpopulations (NHANES, n = 11353; Kailuan, n = 8766). RESULTS In the healthier NHANES subset, 6 hr was associated with significantly higher Usg and odds of inadequate hydration (adjusted OR: 1.59, 95% CI: 1.25, 2.03) compared with 8 hr. Regression results were mixed using Uosm, but in the same direction as Usg. Among Chinese adults, short sleep duration (<6 and 6 hr) was associated with Usg and higher likelihood of inadequate hydration (6 hr adjusted OR: 1.42, 95% CI: 1.26, 1.60). No consistent association was found with sleeping ≥9 hr. CONCLUSIONS Short sleep duration was associated with higher odds of inadequate hydration in US and Chinese adults relative to sleeping 8 hr.
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3.
Reliability of Urinary Dehydration Markers in Elite Youth Boxers.
Zubac, D, Cular, D, Marusic, U
International journal of sports physiology and performance. 2018;(3):374-381
Abstract
PURPOSE To determine the reliability and diagnostic accuracy of noninvasive urinary dehydration markers in field-based settings on a day-to-day basis in elite adolescent amateur boxers. METHODS Sixty-nine urine samples were collected daily from 23 athletes (17.3 ± 1.9 y) during their weight-stable phase and analyzed by field and laboratory measures of hydration status. Urine osmolality (UOSM), urine specific gravity (USG), total protein content (TPC), and body-mass stability were evaluated to determine fluid balance and hydration status. Overall macronutrient and water intake were determined using dietary records. According to their anthropometric characteristics, athletes were assigned into 2 groups: lightweight (LWB) and heavyweight (HWB) boxers. RESULTS Data presented on UOSM demonstrated a uniform increment by 11.2% ± 12.8% (LWB) and 19.9% ± 22.7% (HWB) (P < .001) over the course of the study, even during the weight-stable phase (body mass, ICC = .99) and ad libitum fluid intake (42 ± 4 mL · kg-1 · d-1). The intraclass correlation coefficients (ICCs) ranged from .52 to .55 for USG and .38 to .52 for UOSM, further indicating inconsistency of the urinary dehydration markers. Poor correlations were found between USG and TPC metabolites (r = .27, P = .211). CONCLUSIONS Urinary dehydration markers (both USG and UOSM) exhibit high variability and seem to be unreliable diagnostic tools to track actual body-weight loss in real-life settings. The ad libitum fluid intake was apparently inadequate to match acute fluid loss during and after intense preparation. The applicability of a single-time-point hydration-status assessment concept may preclude accurate assessment of actual body-weight deficits in youth boxers.
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4.
Effect of Fluid Intake on Hydration Status and Skin Barrier Characteristics in Geriatric Patients: An Explorative Study.
Akdeniz, M, Boeing, H, Müller-Werdan, U, Aykac, V, Steffen, A, Schell, M, Blume-Peytavi, U, Kottner, J
Skin pharmacology and physiology. 2018;(3):155-162
Abstract
BACKGROUND/AIM: Inadequate fluid intake is assumed to be a trigger of water-loss dehydration, which is a major health risk in aged and geriatric populations. Thus, there is a need to search for easy to use diagnostic tests to identify dehydration. Our overall aim was to investigate whether skin barrier parameters could be used for predicting fluid intake and/or hydration status in geriatric patients. METHODS An explorative observational comparative study was conducted in a geriatric hospital including patients aged 65 years and older. We measured 3-day fluid intake, skin barrier parameters, Overall Dry Skin Score, serum osmolality, cognitive and functional health, and medications. RESULTS Forty patients were included (mean age 78.45 years and 65% women) with a mean fluid intake of 1,747 mL/day. 20% of the patients were dehydrated and 22.5% had an impending dehydration according to serum osmolality. Multivariate analysis suggested that skin surface pH and epidermal hydration at the face were associated with fluid intake. Serum osmolality was associated with epidermal hydration at the leg and skin surface pH at the face. Fluid intake was not correlated with serum osmolality. Diuretics were associated with high serum osmolality. CONCLUSIONS Approximately half of the patients were diagnosed as being dehydrated according to osmolality, which is the current reference standard. However, there was no association with fluid intake, questioning the clinical relevance of this measure. Results indicate that single skin barrier parameters are poor markers for fluid intake or osmolality. Epidermal hydration might play a role but most probably in combination with other tests.
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5.
Development of a screening tool to assess dehydration in hospitalized older population: a diagnostic, observational study.
Guastaferro, R, Rosi, IM, Milos, R, Messina, E, Cerra, A, Bonetti, L
Professioni infermieristiche. 2018;(3):178-187
Abstract
INTRODUCTION dehydration is a frequent condition in older people and is associated with an increased risk of negative health outcomes. In order to adopt strategies to prevent complications, an early recognition of this status is of primary importance. For this reason, a comprehensive assessment tool to monitor hydration status in older people could be useful. AIM: to develop a screening tool to detect dehydration in older people in hospital settings. METHODS this is a diagnostic, observational study. The new tool is a modified version of the Geriatric Dehydration Screening Tool (GDST), integrated with seven questions and two clinical signs based on updated literature. We tested the new tool with people aged 65 or over. We used as reference standard serum osmolarity. Cronbach's alpha was used to measure the tool's reliability and subscales. We calculated the Area Under ROC Curve (AUC) to choose the cut-off that gave the best balance between sensibility and specificity. RESULTS 127 patients participated in the study. The reliability of the new GDST was acceptable (Cronbach's alpha 0.63). The diagnostic accuracy, measured with AUC analysis, was 0.83 ± 0.04, p 0.0001 95% CI 0.72-0.87. The best cut-off value was 6 and showed a sensibility of 78%, specificity of 70%. Tongue dryness proved to be the most significant clinical sign associated with poor hydration status (AUC 0.78; p 0.0001, 95% CI 0.69-0.86). CONCLUSION The new GDST presented an acceptable reliability and diagnostic accuracy that increased with the assessment of some items, such as tongue dryness. This is the first screening tool that presents a promising cut-off value.
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6.
Evaluation of the effects of fasting associated dehydration on maternal NGAL levels and fetal renal artery Doppler parameters.
Bayoglu Tekin, Y, Guvendag Guven, ES, Mete Ural, U, Yazici, ZA, Kirbas, A, Kir Sahin, F
The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians. 2016;(4):629-32
Abstract
OBJECTIVE The aim of this study was to evaluate maternal neutrophil gelatinase-asssociated lipocalin (NGAL) levels and fetal renal artery (fRA) Doppler flow indices in pregnant women fasting in Ramadan in respect of dehydration in long hot summer days as a marker of hypoperfusion and early renal injury. METHODS A cross-sectional observational study was carried out at a University Hospital. Fasting pregnant women and non-fasting age, gravidity and gestational age-matched women were evaluated for hematologic, blood biochemistry and urine parameters in the first and fourth weeks of the Ramadan. Umbilical artery and fRA Doppler flows were studied in each evaluation. RESULTS Blood urea nitrogen, potassium and hematocrit levels, blood and urine NGAL levels were significantly higher, and fRA Doppler indices increased in fasting women (p < 0.05) during the second visit in the last week of the Ramadan, while non-fasting women had no significant alterations in each evaluation (p > 0.05). CONCLUSIONS Adequate maternal vascular volume is essential for the maintenance of healthy pregnancy. Fasting during the long and hot summer days leads to fluid deprivation and dehydration which was found to be related to subclinical maternal renal dysfunction and increased fRA Doppler indices.
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7.
Short-term body weight fluctuations in older well-hydrated hospitalised patients.
Vivanti, A, Yu, L, Palmer, M, Dakin, L, Sun, J, Campbell, K
Journal of human nutrition and dietetics : the official journal of the British Dietetic Association. 2013;(5):429-35
Abstract
BACKGROUND The usual daily weight fluctuations of well-hydrated older hospitalised people have not been documented internationally. To date, dehydration assessments based on a short-term body weight change defined as >2% have been drawn from healthy population data. The present pilot study aimed to describe usual body weight fluctuation at the same time of day over a 3-day time frame in well-hydrated older hospitalised adults. METHODS An observational study of non-acute inpatients (n = 10) admitted to a Geriatric and Rehabilitation Unit, aged ≥60 years, assessed as well-hydrated, mobile, non-amputee and without conditions that influenced fluid status, was conducted. Participants were weighed hourly over a 9-h period for 3 days. Food and fluid intake, clothing items added or removed, and urine and faecal output were recorded. RESULTS Weight fluctuation for each participant [mean (SD) 80.2 (4.2) years; male 60.0%, n = 10] over 3 days ranged from 1.1% to 3.6%. Over 3 days, 40.0% (4/10) of participants had weight fluctuations of >2% and 20% (2/10) had weight fluctuations of >3%. Time of weigh-in accounted for 99.8% of the variation in weight fluctuation (P < 0.05), with the lowest fluctuations observed when weights were compared at the same time each day (≤0.4 kg). CONCLUSIONS Weights recorded at the same time daily had the greatest accuracy. Given that the range 1.1-3.6% was within normal weight fluctuations for well-hydrated older hospitalised participants, the weight change indicative of dehydration remains to be established in this setting but appears greater than conventionally used figures.