Validation of Surrogates of Urine Osmolality in Population Studies

Am J Nephrol. 2017;46(1):26-36. doi: 10.1159/000475769. Epub 2017 Jun 7.


Background: The importance of vasopressin and/or urine concentration in various kidney, cardiovascular, and metabolic diseases has been emphasized recently. Due to technical constraints, urine osmolality (Uosm), a direct reflect of urinary concentrating activity, is rarely measured in epidemiologic studies.

Methods: We analyzed 2 possible surrogates of Uosm in 4 large population-based cohorts (total n = 4,247) and in patients with chronic kidney disease (CKD, n = 146). An estimated Uosm (eUosm) based on the concentrations of sodium, potassium, and urea, and a urine concentrating index (UCI) based on the ratio of creatinine concentrations in urine and plasma were compared to the measured Uosm (mUosm).

Results: eUosm is an excellent surrogate of mUosm, with a highly significant linear relationship and values within 5% of mUosm (r = 0.99 or 0.98 in each population cohort). Bland-Altman plots show a good agreement between eUosm and mUosm with mean differences between the 2 variables within ±24 mmol/L. This was verified in men and women, in day and night urine samples, and in CKD patients. The relationship of UCI with mUosm is also significant but is not linear and exhibits more dispersed values. Moreover, the latter index is no longer representative of mUosm in patients with CKD as it declines much more quickly with declining glomerular filtration rate than mUosm.

Conclusion: The eUosm is a valid marker of urine concentration in population-based and CKD cohorts. The UCI can provide an estimate of urine concentration when no other measurement is available, but should be used only in subjects with normal renal function.

Keywords: Chronic kidney disease; Circadian rhythm; Potassium; Sodium; Urea; Water balance.

Publication types

  • Multicenter Study
  • Validation Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Biomarkers / urine
  • Cohort Studies
  • Creatinine / blood
  • Creatinine / urine
  • Female
  • Glomerular Filtration Rate
  • Humans
  • Kidney / physiopathology
  • Male
  • Middle Aged
  • Neurophysins / metabolism
  • Osmolar Concentration
  • Potassium / urine*
  • Protein Precursors / metabolism
  • Renal Elimination
  • Renal Insufficiency, Chronic / blood
  • Renal Insufficiency, Chronic / metabolism
  • Renal Insufficiency, Chronic / physiopathology
  • Renal Insufficiency, Chronic / urine*
  • Sodium / urine*
  • Urea / urine*
  • Urine / chemistry*
  • Vasopressins / metabolism
  • Young Adult


  • AVP protein, human
  • Biomarkers
  • Neurophysins
  • Protein Precursors
  • Vasopressins
  • Urea
  • Sodium
  • Creatinine
  • Potassium