Effect of chronic oral testosterone undecanoate administration on the pituitary testicular axis of hemodialyzed male patients

Testosterone undecanoate (TU) or placebo was administered orally (for 12 weeks) in a double blind study, to 19 patients with chronic renal insufficiency on hemodialysis in a daily dose of 240 mg. Effect on plasma testosterone (T), dihydrotestosterone (DHT), androstenedione (A), 110H androstenedione (110A), FSH, LH and PRL concentration and the pituitary responsiveness to LH-RH/TRH stimulation was studied. These hormone levels were determined before the study and after 6 and 12 weeks of treatment. There was a rise in plasma androgen concentration in all treated patients. Mean plasma DHT, A and 110A increased at 12 weeks from 0.3, 0.85 and 1.13 ng/ml to 1.13 (p less than 0.05), 1.4 (p less than 0.05) and 1.44 (p less than 0.05) respectively. There was no change in plasma T or free testosterone. However, basal LH, FSH fell progressively from 5.51 and 5.51 ng/ml to 2.13 and 1.84 ng/ml (p less than 0.05). The level of significance of these changes was confirmed when the response to LH-RH was considered. Basal plasma PRL also decreased from 376 microU/nl to 306 (p less than 0.05), but PRL response to TRH remained unchanged. In contrast, none of these modifications were observed in placebo-treated patients. We conclude that oral TU restored to normal the pituitary-testicular axis. This form of treatment should be preferentially chosen instead of intramuscular injections in these frequently heparinized patients on hemodialysis.Clinical TrialControlled Clinical TrialJournal ArticleSCOPUS: ar.jinfo:eu-repo/semantics/publishe

Blood urea nitrogen, middle molecules and uremic morbidity in hemodialyzed patients

The adequacy of dialysis remains debatable. We compared the morbidity in our hemodialyzed patients according to predialysis blood urea nitrogen (BUN) levels, on the one hand, and to calculated middle molecule clearance (MMC = residual creatinine clearance + vitamin B12 clearance of the dialyzer), on the other hand. Patients with systemic diseases or with residual creatinine clearances above 3 ml/min were excluded. Fifty-one patient, incorporated into the same dialysis schedule, were studied during a follow-up of six to 30 months. Analyses of the data were conducted in the following two ways: Analysis A compared patients with BUN = 115 ± 12 mg/dl (n = 26) to patients with BUN = 85 ± 9 mg/dl (n = 25), while analysis B compared patients with MMC = 37 ± 8 (n = 26) to patients with MMC = 16 ± 5 (1/week; n = 25). In analysis A, both groups of patients had comparable MMC; in analysis B, both groups of patients had similar BUN. The following parameters were recorded: creatinine clearance, age, sex, weight, mortalities, hepatitis, pericarditis, bacterial infection, gastrointestinal diseases, duration of hospitalization, iPTH levels, motor nerve conduction velocity, blood pressure, hematologic values, number of transfusions. Among all these parameters, only the need for transfusions was higher in patients with higher BUN (24.8 v 14.4 units/patient/year, P < .001) for similar hematocrit. Lower MMC was associated with significantly higher morbidity (2.12 v 1.33 recorded complications/patient/year, P < .05), as well as with longer hospitalization (15.5 v 5.3 days/patient/year, P < .001). In our experience, overall morbidity was better correlated with the loss in MMC than with BUN levels, except for the need for transfusions. Monitoring of motor nerve conduction velocity did not seem useful for detecting underdialysis.SCOPUS: NotDefined.jinfo:eu-repo/semantics/publishe

Complications related to subcalvian catheters for hemodialysis: report and review

Personal experience with subclavian vein cannulations for hemodialysis are given, and the pertinent literature on the subject is reviewed. Two hundred subclavian dialysis catheters were placed in 148 patients who kept them in place for a total of 2,798 days. Immediate complications were two pneumothoraxes and two hemothoraxes due to subclavian artery puncture. Seventeen cases of bacteremia were related to subclavian catheter infections. In 1 case, a complication of sepsis was a vertebral osteomyelitis. Clinical evidences of subclavian vein thrombosis occurred in 5 cases. Life-threatening complications were met in 2 cases: 1 with pericardial tamponade due to right atrium perforation and 1 with mediastinal hematoma and right hemothorax due to superior vena cava perforation. Review of the literature indicates that pneumothoraxes and/or hemothoraxes occurred in 1.7% of the catheter insertions and that sepsis related to subclavian dialysis catheters occurred in 8.9% of the patients. As systematically investigated subclavian vein thrombosis involved at least 50% of the patients. Our 2 personal cases of life-threatening complications and 14 similar cases of the literature were analyzed: left subclavian catheters were associated with superior vena cava perforation with right hemothorax or mediastinal hematoma, while right subclavian catheters gave atrial perforation with pericardial tamponade. Death occurred in 3 of 16 cases, and emergency surgery was required in 5 of 16 cases. Taking into account all these complications, recommendations are made for the use of subclavian dialysis catheters.Case ReportsJournal Articleinfo:eu-repo/semantics/publishe

Effets comparés sur l'excrétion urinaire des ions et de l'acide oxalique de charges orales en eaux de compositions minérales différentes

The effects on urinary excretion of a 1500 ml daily load of three drinking waters with different ionic contents were studied in six normal subjects. Diuresis was similarly increased by the three waters of an amount equal to the load. Urine output of urea, creatinin, uric acid, phosphate, potassium, magnesium was not significantly modified by the three waters as compared to a control period. Natriuresis was significantly increased following the intake of the water which contained sodium as well as calciuria with the water containing calcium. Urine output of oxalate was increased by the three waters in correlation with the free water content of the load. This effect is probably due to a reduction in passive tubular reabsorption of oxalate since a similar effect was observed with an equivalent water load given by intravenous route. Nevertheless, due to the dilution of urine, the index of urine saturation for calcium oxalate was diminished by the three waters.Comparative StudyEnglish AbstractJournal ArticleSCOPUS: NotDefined.jinfo:eu-repo/semantics/publishe

Infections associated with subclavian dialysis catheters

Two hundred subclavian dialysis catheters were placed in 148 patients who kept them in place for a total of 2,798 days. Catheterization time ranged from 1 to 79 days with an average of 14.0 +/- 1.0 days per catheter and 18.9 +/- 1.0 days per patient. Twenty nine catheters were infected, 17 of which were the source of bacteremias due to Staphylococcus epidermidis in 13 cases and to Staphylococcus aureus in 4 cases. The incidence of sepsis was not significantly greater in diabetic patients, in patients with corticotherapy or in patients presenting an underlying systemic disease. On the contrary, the incidence was greater in hospitalized patients (15 bacteremias during 1,948 catheter days) than in ambulatory patients (2 bacteremias during 850 catheters-days) as well as during a period corresponding to a greater number of untrained nurses enrolled in the dialysis team. During this period, 6 sepsies occurred in 19 catheters (other periods: 7 sepsies/116 catheters, p less than 0.01). 6 of 28 nurses had less than 3 months of professional experience (other periods: 1 of 25, p less than 0.01). These data underline the key role of nurse training in the prevention of catheter-related infections.Comparative StudyJournal ArticleSCOPUS: ar.jinfo:eu-repo/semantics/publishe

ACE inhibitors and anaphylactoid reactions to high flux membrane dialysis

CommentLetterSCOPUS: le.jinfo:eu-repo/semantics/publishe