Long-Term Desmopressin Treatment Is Effective and Safe for Nighttime Urination in Older Men

What the researchers found

In 133 men (mean age 77.7 years) with nocturnal polyuria treated with desmopressin 50 μg:

- 87.6% showed improved symptoms at 52 weeks (score ≤ 3)

- Improvements sustained across all efficacy endpoints: nocturnal urinary frequency, nocturnal urinary volume, hours of undisturbed sleep, nocturnal polyuria index, initial nocturnal urinary volume, and daily urinary frequency

- Improvements were measured at 1, 4, 12, 24, and 52 weeks

- BNP (brain natriuretic peptide) level rose over the year, but cardiothoracic ratio on chest X-ray was unchanged

- Body composition was not significantly affected

- Long-term administration deemed effective and safe in older men

Why it matters

Nocturia is one of the most common and bothersome urinary symptoms in older adults, severely affecting sleep quality and increasing fall risk. While desmopressin is effective, concerns about water retention and cardiac effects in elderly patients have limited long-term use. This study provides reassuring real-world evidence that the peptide drug can be used safely for at least one year in older men.

How the study worked

Retrospective study at Chikugo City Hospital (August 2020 – December 2022) involving 133 men with nocturnal polyuria. Patients received an initial dose of desmopressin 50 μg. Efficacy was assessed using 3-day frequency-volume charts at baseline and 1, 4, 12, 24, and 52 weeks. Safety was monitored through BNP levels and chest X-ray (cardiothoracic ratio) at baseline and 52 weeks.

What this study cannot tell us

This was a retrospective, single-center study without a control group or blinding. The BNP increase, while not accompanied by cardiac structural changes, warrants monitoring. Only men were included, so results may not apply to women. The study did not track sodium levels, which can drop dangerously with desmopressin use (hyponatremia). Some patients may have dropped out due to side effects, potentially biasing the 87.6% improvement rate.

How to read the evidence

This is a retrospective single-center study without a control group. While the 52-week follow-up and large-for-nocturia sample size provide useful data, the lack of randomization and blinding limits the strength of conclusions.

When this study was published

Published in 2024 with data from 2020–2022, this provides current evidence on long-term desmopressin safety in the elderly population.

The bigger picture

Desmopressin is a classic example of a therapeutic peptide — a synthetic analog of the natural hormone vasopressin (antidiuretic hormone). Originally developed for diabetes insipidus and bedwetting, its use has expanded to adult nocturia. This study helps address the safety gap for long-term use in elderly patients, a population where nocturia is most prevalent but also where fluid-related risks are highest.

Questions still open

• Does the observed BNP increase with long-term desmopressin represent a clinically meaningful cardiac risk over multiple years?
• How does desmopressin's long-term safety compare in women versus men with nocturia?
• Should sodium monitoring be routine during long-term desmopressin therapy in elderly patients?

Common questions

Read the original research

Effects of long-term desmopressin treatment for nocturia in older people.

International journal of urology : official journal of the Japanese Urological Association, 31(10), 1114-1120

Citation

Kurose, Hirofumi; Ueda, Kosuke; Chikui, Katsuaki; Uemura, Keiichiro; Nishihara, Kiyoaki; Nakiri, Makoto; Suekane, Shigetaka; Igawa, Tsukasa. (2024). Effects of long-term desmopressin treatment for nocturia in older people.. International journal of urology : official journal of the Japanese Urological Association, 31(10), 1114-1120. https://doi.org/10.1111/iju.15530