From the Guidelines
Older adults with Nephrogenic Diabetes Insipidus (NDI) should receive comprehensive education and behavioral counseling to manage their condition, focusing on proper fluid management, medication adherence, and dietary adjustments, as recommended by the latest expert consensus statement 1. The counseling should prioritize teaching patients how to maintain adequate hydration while avoiding overhydration, recognizing early signs of dehydration, and establishing regular drinking schedules rather than relying solely on thirst.
- Medication adherence counseling is crucial, as patients will likely need to continue medications such as thiazide diuretics, potassium-sparing diuretics, or NSAIDs, which paradoxically reduce urine output in NDI.
- Dietary counseling should address sodium restriction to reduce urine volume and proper potassium intake if on thiazides.
- Patients should also receive guidance on managing NDI during special circumstances like physical activity, illness, and travel, including how to adjust fluid intake and recognize when to seek medical attention, as outlined in the expert consensus statement 1.
- Additionally, having an emergency plan in place, including a letter explaining the diagnosis and containing advice regarding intravenous fluid management, and wearing a medical alert bracelet or card, is strongly recommended 1.
- Psychological support may also be beneficial to address the social and emotional challenges of living with a chronic condition that requires frequent urination and constant hydration. The goal of this counseling is to provide patients with the necessary tools to manage their NDI effectively, reduce the risk of complications, and improve their overall quality of life, as emphasized by the international expert consensus statement 1.
From the Research
Counseling for Managing Nephrogenic Diabetes Insipidus (NDI) in Older Adults
- The management of NDI should focus on free access to drinking water and reduction of polyuria 2.
- Therapeutic options for NDI include nonpharmacological interventions, such as sufficient water intake and a low-sodium diet, and pharmacological treatment 3.
- Medications used for NDI include thiazide diuretics, nonsteroidal anti-inflammatory drugs (NSAIDs), and amiloride, used isolated or in combination 3.
- A combination of hydrochlorothiazide and amiloride has been shown to be effective in treating NDI, with minimal side effects 4.
- It is essential to evaluate water balance and respond quickly with strict protocols when initiating treatment with indomethacin and thiazide diuretics in NDI 5.
- Management of NDI can be difficult, with only symptomatic treatment available, using a low-solute diet, diuretics, and prostaglandin inhibitors 6.
Considerations for Older Adults
- Older adults with NDI may require closer monitoring of their fluid balance and electrolyte levels due to age-related changes in renal function 3.
- The treatment of NDI in older adults should aim to decrease urine output while allowing appropriate fluid balance, normonatremia, and ensuring an acceptable quality of life 3.