Abstract
Objectives
Older adults have an elevated risk of dehydration, a state with proven detrimental
cognitive and physical effects. Furthermore, the use of diuretics by hypertensive
patients further compounds this risk. This prospective study investigated the diagnostic
accuracy of point-of-care (POC) salivary osmolarity (SOSM) measurement for the detection
of dehydration in hypertensive adults with and without diuretic pharmacotherapy.
Design
Prospective diagnostic accuracy study.
Setting
Home visits to patients recruited from 4 community health centers in West Sulawesi,
Indonesia.
Participants
A total of 148 hypertensive older adults (57 men, 91 women). The mean ages of male
and female patients were 69.4 ± 11.4 and 68.1 ± 7.8 years, respectively.
Methods
Hypertensive adults were divided into 2 groups based on the presence of diuretics
in their pharmacotherapeutic regimen. First-morning mid-stream urine samples were
used to perform urine specific gravity (USG) testing. Same-day SOSM measurements were
obtained using a POC saliva testing system.
Results
Both USG (P = .0002) and SOSM (P < .0001) were significantly elevated in hypertensive patients with diuretic pharmacotherapy.
At a USG threshold of ≥1.030, 86% of diuretic users were classified as dehydrated
compared with 55% of non-using participants. A strong correlation was observed between
USG and SOSM measurements (r = 0.78, P < .0001). Using a USG threshold of ≥1.030 as a hydration classifier, an SOSM threshold
of ≥93 mOsm had a sensitivity of 78.6% and a specificity of 91.1% for detecting dehydration.
Conclusions and Implications
Hypertensive patients on diuretics have significantly higher first-morning USG and
SOSM values, indicating a higher likelihood of dehydration relative to those on other
classes of antihypertensive medication. POC SOSM assessment correlates strongly with
first-morning USG assessment, and represents a rapid and noninvasive alternative to
urinary hydration assessment that may be applicable for routine use in populations
with elevated risk of dehydration.
Keywords
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Article info
Publication history
Published online: September 26, 2022
Footnotes
N.M.A. and G.V.S. contributed equally.
The study was partially funded by MX3 Diagnostics.
MX3 Diagnostics Inc. manufactures the MX3 Hydration Testing System, the salivary osmometer used in this study. E.S. is a member of the MX3 Diagnostics Board of Directors and has partial ownership of the company. M.E and G.C. are employees of MX3 Diagnostics. E.S., G.C., and M.E are authors of patents related to salivary osmolarity testing and the MX3 Hydration Testing System.
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