Urine specific gravity to identify and predict hydration need in ALS

Waqar Waheed, Fatima Khan, Shelly Naud, Edward Kasarskis, Dwight Matthews, Rup Tandan

Research output: Contribution to journalArticlepeer-review


Introduction: Multiple factors contribute to increased risk of dehydration in amyotrophic lateral sclerosis (ALS), which contributes to shortened survival independent of nutritional status. The assessment of hydration by doubly labeled water is restricted due to the limited availability of this gold standard technique for clinical use. This prompted us to examine the utility of urine-specific gravity (USG) as a predictor of hydration need in ALS subjects. Material and Methods: Using data from a multicenter study of 80 ALS subjects with 250 visits, we conducted a secondary analysis of the original data set from doubly labeled water experiments. We used a cross-section of the data (one visit per 75 subjects) in the model selection step (“test set”), and a repeated measures analysis in the validation step with data from 63 subjects and 142 follow-up visits. The sensitivity to detect inadequate water turnover rate (a surrogate for water intake) was the goal of the predictive model presented for clinical use. Results and discussion: The final predictive model to estimate water requirement included USG, gender, body mass index, and the ALSFRS gross motor subscale score. We developed a best-fit equation to estimate water intake from USG, determine hydration status, and improve clinical care of real-world ALS subjects.

Original languageEnglish
Pages (from-to)407-414
Number of pages8
JournalAmyotrophic Lateral Sclerosis and Frontotemporal Degeneration
Issue number5-6
StatePublished - 2022

Bibliographical note

Publisher Copyright:
© 2021 World Federation of Neurology on behalf of the Research Group on Motor Neuron Diseases.


  • ALS
  • doubly labeled water
  • urine specific gravity
  • water intake
  • water turnover

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology


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