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The risk of dehydration in older adults with neurocognitive disorder (NCD) is controversial. The purpose of this study was to assess hydration status, its determinants, and water intake sources in older adults with NCD. A sample of 30 participants (≥60 years) was included. Sociodemographic, clinical data and one 24-h urine sample were collected. Urinary osmolality, sodium, potassium, volume, and creatinine were quantified. Inadequate hydration status corresponded to urine osmolality > 500 mOsm/Kg, or a negative Free Water Reserve (FWR). Two 24-h food recalls were used to assess dietary intake and water sources. The adequacy of total water intake (TWI) was estimated according to EFSA. The contribution of food and beverages to TWI was calculated, and their associations with the urinary osmolality median were tested. Of the total number of participants, 30% were classified as having inadequate hydration status, with no differences between sexes. Regarding TWI, 68.4% of women and 77.8% of men did not reach the reference values. Water (23%), followed by soup (17%), contributed the most to TWI, while vegetables (2%) and alcoholic/other beverages (3%) contributed the least. According to the median urinary osmolality, there was no significant difference in sociodemographic/clinical characteristics. It is critical not to overlook hydration in this vulnerable population.

Introduction Lithium is the gold-standard treatment for bipolar disorder, is highly effective in major depressive disorder, and is being investigated for therapeutic benefits in dementia, stroke, and even cancer. Approximately 350,000 Canadians use lithium and more could benefit. Despite this, clinicians are avoiding lithium, largely due to fear of renal toxicity, including irreversible chronic kidney disease (CKD). Nephrogenic Diabetes Insipidus (NDI) occurs in 20% of lithium users and independently predicts a 2-3 times increased risk of CKD. To date, amiloride is the only medication with randomized controlled trial (RCT) evidence for treating NDI, however it can increase lithium toxicity risk. There is a need for novel, well-tolerated treatments for NDI. We recently found that statins are associated with lower NDI risk in a cross-sectional study (n=71 lithium users). 0% (0/17) of statin users compared to 20.4% (11/54) of non-users had NDI (p=0.055), with atorvastatin 10-40mg/day being the main statin used. Mice studies from our collaborators have also been promising. We present the protocol for a pilot human RCT of statins in NDI to guide a larger confirmatory RCT. Methods We propose a 12-week, double-blind placebo-controlled pilot RCT of atorvastatin in patients with lithium-induced NDI. We will recruit 60 psychiatric patients, aged 18-85, who are on a stable lithium dose for ≥2 months and who have NDI, defined as a 10-hour fluid restriction urine osmolality (UOsm) Results The protocol of this study will be presented. Results will be ready in late 2019. Conclusions Atorvastatin is found to be useful in treating NDI, lithium could be used more safely in patients with a reduced subsequent risk of CKD, as well as hypernatremia, and acute kidney injury (AKI). This could also allow many additional patients with bipolar disorder, depression, and other psychiatric/neurological conditions to benefit from lithium. This could also potentially prevent medical health service utilization related to psychiatric, neurological, and renal disease, saving significant health costs. This research was funded by Kidney Foundation of Canada

High fluid intake has been universally recommended for kidney stone prophylaxis. We evaluated 24-h urine osmolality regarded as the best biomarker of optimal hydration and upper metastable limit osmolality after water evaporation from urine sample to the onset of spontaneous crystallization and its usefulness as a new risk index that would describe an individual lithogenic potential. We collected 24-h urine from 257 pediatric patients with kidney stones and 270 controls. After volume and osmolality assessment, the urine samples were subjected to volume reduction in vacuum rotavapor continued to the onset of an induced urinary crystallization. The upper metastable limit osmolality of urine sample was calculated based on its initial osmolality value and the amount of water reduction. Pediatric stone formers presented with higher urine volume and lower urine osmolality than healthy controls. Despite that, their urine samples required much lower volume reduction to induce the spontaneous crystallization than those of controls. The ROC analysis revealed an AUC for the upper metastable limit osmolality of 0.9300 (95% CI 0.9104-0.9496) for distinguishing between stone formers and healthy subjects. At the cutoff of 2696 mOsm/kg, the test provided sensitivity and specificity of 0.8638 and 0.8189, respectively. 24-h urine osmolality provided the information about current hydration status, whereas evaporation test estimated the urinary potential to crystalize dependent on urine composition. Upper metastable limit osmolality may estimate the individual lithogenic capability and identify people at risk to stone formation when exposed to dehydration.