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Water excretion in the elderly.

P J Davis1, F B Davis

  • 1Department of Medicine, State University of New York, Buffalo School of Medicine.

Endocrinology and Metabolism Clinics of North America
|December 1, 1987
PubMed
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Elderly individuals show increased vasopressin (AVP) secretion but reduced kidney concentrating ability. Medications decreasing free water reabsorption (CH2O) contribute to hyponatremia risk in older adults.

Area of Science:

  • Nephrology
  • Gerontology
  • Endocrinology

Background:

  • Aging affects osmoregulation, with enhanced osmoreceptor sensitivity and increased arginine vasopressin (AVP) secretion in the elderly.
  • Despite increased AVP, the aged kidney exhibits decreased collecting tubule sensitivity to AVP, leading to reduced maximal urine osmolality (Uosm).

Purpose of the Study:

  • To investigate the mechanisms underlying reduced concentrating ability in the elderly.
  • To clarify the role of altered AVP secretion and kidney sensitivity in age-related changes in water balance.
  • To assess the contribution of pharmacologic agents to hyponatremia risk in older adults.

Main Methods:

  • Comparison of osmoreceptor sensitivity and AVP secretion between elderly and younger subjects under varying plasma osmolality.

Related Experiment Videos

  • Assessment of renal concentrating ability (maximum Uosm) under hydropenic conditions in different age groups.
  • Evaluation of the relationship between glomerular filtration rate (GFR) and the kidney's ability to handle free water (CH2O).

    • Main Results:

    • Elderly subjects exhibit heightened osmoreceptor sensitivity and increased AVP secretion relative to plasma osmolality changes.
    • Reduced collecting tubule sensitivity to AVP in the aged kidney impairs maximal Uosm, even with elevated AVP levels.
    • CH2O decreases proportionally with GFR decline; however, minimal Uosm remains adequate for water intake demands in most elderly individuals with reduced GFR.

    Conclusions:

    • The reduced concentrating ability in the elderly is due to decreased kidney sensitivity to AVP, not solely impaired AVP release.
    • While age-related GFR decline impacts CH2O, it does not typically lead to hypo-osmolarity.
    • Pharmacologic agents that reduce CH2O significantly increase the risk of hyponatremia in the elderly.