Background: With the current practice of using estimated glomerular filtration rate (eGFR) for the assessment of renal function, serum urea is arguably a redundant test. However, with little evidence, it is purported that urea can be used as a marker to aid in the assessment of hydration status. The aim of this study was to compare serum urea and eGFR with urine specific gravity (USG) to establish how each compares with this surrogate marker of hydration status. Methods: The study subjects comprised 2,547 separate acute hospital attendances (1,489 female, 1,058 male; median age (IQR) 60 (39–81) years) where USG and serum urea and creatinine were measured immediately on admission. Results: A significant rise in the median serum urea concentration was observed with increasing categories of USG (p < 0.0001). In contrast, a significant trend was not observed for eGFR vs. USG (p = 0.65). Conclusion: Serum urea concentration is significantly affected by hydration status whereas eGFR is not.

1.
Kopple JD, Coburn JW: Evaluation of chronic uraemia. Importance of serum urea nitrogen, serum creatinine and their ratio. JAMA 1974;227:41–44.
2.
Morgan DB: Why plasma electrolytes? Ann Clin Biochem 1981;18:275–280.
3.
Penney MD, Swaminathan R: Standardisation of the U&E profile. www.acb.org.uk/docs/ueprofile.pdf.
4.
Warren JL, Bacon WE, Harris T, McBean AM, Foley DJ, Phillips C: The burden and outcomes associated with dehydration among us elderly, 1991. Am J Public Health 1994;84:1265–1269.
5.
Sinert R, Spektor M: Evidence-based emergency medicine/rational clinical examination abstract. Clinical assessment of hypovolemia. Ann Emerg Med 2005;45:327–329.
6.
Armstrong LE, Soto JA, Hacker FT Jr, Casa DJ, Kavouras SA, Maresh CM: Urinary indices during dehydration, exercise, and rehydration. Int J Sport Nutr 1998;8:345–355.
7.
Su SB, Lin KH, Chang HY, Lee CW, Lu CW, Guo HR: Using urine specific gravity to evaluate the hydration status of workers working in an ultra-low humidity environment. J Occup Health 2006;48:284–289.
8.
Popowski LA, Oppliger RA, Patrick Lambert G, Johnson RF, Kim Johnson A, Gisolf CV: Blood and urinary measures of hydration status during progressive acute dehydration. Med Sci Sports Exerc 2001;33:747–753.
9.
Levey AS, Greene T, Kusek JW, Beck GJ: MDRD study group, a simplified equation to predict glomerular filtration rate from serum creatinine. J Am Soc Nephrol 2000;11:155A.
10.
Gross CR, Lindquist RD, Woolley AC, Granieri R, Allard K, Webster B: Clinical indicators of dehydration severity in elderly patients. J Emerg Med 1992;10:267–274.
11.
McGee S: Evidence-Based Physical Diagnosis. Philadelphia, Saunders, 2001, pp 1–100.
12.
Morgan DB, Carver ME, Payne RB: Plasma creatinine and urea: creatinine ratio in patients with raised plasma urea. Br Med J 1977;2:929–932.
13.
Comtois R, Bertrand S, Beauregard H, Vinay P: Low serum urea level in dehydrated patients with central diabetes insipidus. CMAJ 1988;139:965–969.
14.
Cox HJ, Bhandari S, Rigby AS, Kilpatrick ES: Mortality at low and high estimated glomerular filtration rate values: a U-shaped curve. Nephron Clin Pract 2008;110:C67–C72.
15.
Kavouras SA: Assessing hydration status. Curr Opin Clin Nutr Metab Care 2002;5:519–524.
16.
Burkhardt AE, Johnston KG, Waszak CE, Jackson CE, Shafer SR: A reagent strip for measuring the specific gravity of urine. Clin Chem 1982;28:2068–2072.
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