The Validity of Urine Color as a Hydration Biomarker within the General Adult Population and Athletes: A Systematic Review

Abstract

Frequent monitoring of hydration status may help to avoid the adverse effects of dehydration. Other than urine color assessment, hydration assessment methods are largely impractical for the general population and athletes to implement on a routine basis. Despite its widespread use, the validity of urine color as an indicator of hydration status has not been systematically evaluated. The objective of this systematic review is to determine the validity of urine color evaluation as a hydration status assessment method in the general adult population, older adults, and athletes. Using the PRISMA guidelines, electronic databases were searched to identify original research articles of all study design types for inclusion. Of the 424 articles screened, 10 met inclusion criteria. Most studies compared urine color to either urinary specific gravity or urine osmolality, and reported significant associations (r) ranging from 0.40 to 0.93. Lower correlations were noted in studies of adults aged >60 years. Studies generally reported a high sensitivity of urine color as a diagnostic tool for detecting dehydration and supported the ability of this method to distinguish across categories of hydration status. Research is needed to determine if clinicians, patients, and clients can accurately utilize this method in clinical and real-world settings. Future research is also needed to extend these findings to other populations, such as children.

Key teaching points

• Inadequate hydration can lead to impairments in physical performance and cognitive function.

• Methods used to assess hydration status include plasma/serum osmolality, urinary specific gravity (USG), urine osmolality (Uosm), change in body weight, urine volume, and urine color.

• Urine color assessment is a practical method that is routinely used in clinical, athletic, and other settings. The validity of this method has not been systemically evaluated.

• Available research was limited to 10 articles.

• Validity of this method was generally supported; however, research has not investigated the validity of this method by clinicians, patients and clients.

Keywords:

• Hydration status
• urine color
• adult
• validity

Acknowledgements

The authors wish to acknowledge Katelyn Barker (K.B.) from Virginia Tech for her assistance with duplication of the article search and full-text article screening processes.

Disclosure statement

The authors declare that they have no conflicts of interest.

Authors’ contributions

SBK designed the review protocol, conducted the literature search, wrote the protocol and report, screened eligible studies, extracted and interpreted the data, screened articles for quality, updated reference lists, created the summary of findings, and led the development of the report.

KPD, VEH, DTT, and BMD assisted with designing the review protocol and data interpretation, provided critical feedback on the report, contributed to writing the report, and approved the final version of the manuscript.

BMD supervised the development of the protocol and report, and screened articles for quality.