Characterization of Nocturia and Urinary Voiding Indices Along the Heart Failure Continuum in US Male Veteran...

Heart failure (HF) is a growing public health crisis that progresses from cardiovascular risk factors to structural/functional heart disease and eventual HF symptoms. Nocturia, long recognized as a HF symptom, has not been characterized along the HF continuum. To characterize nocturia across HF stages, we retrospectively analyzed voiding diaries and clinical data from US male veteran outpatients treated for lower urinary tract symptoms from 2008 to 2022. Patients were categorized into HF stages 0 (no risk factors), A (HF risk factors), B (stage A criteria + structural heart disease), and C (stage B criteria + prototypical HF signs/symptoms). Among 329 men, median actual void number (ANV) differed across HF stages (p = .011) and was maximal at Stage B. Among patients not taking diuretics - nocturnal voiding indices rose progressively through stage C, suggesting diuretic-mediated suppression of nocturia. There were trends toward higher nocturnal urine volume (NUV), nocturnal polyuria index (NPi) and nocturnal maximum voided volume (NMVV) in Stages B and C patient than Stage A. On multivariate analysis, HF stage was predictive of NUV and trended towards predicting ANV, whereas edema was an independent predictor of ANV, NUV, NPi, and NMVV. In a clinical urology population, nocturnal voiding indices were associated with HF stage, with the highest nocturia burden observed in Stage B (pre-HF) and independently with edema. Among men not taking diuretics, nocturia increased progressively through Stage C. These findings support nocturia as an early marker of volume overload that accompanies structural/functional heart disease, potentially preceding overt HF symptoms.