ABSTRACT
We report on a 5-year, prospective, double-blind trial of 1,25 dihydroxycholecalciferol (calcitriol) versus placebo in 76 hemodialysis patients without biochemical or radiological evidence of bone disease. Calcitriol, 1 microgram daily, regularly induced hypercalcemia. Doses of 0.25 microgram daily or less proved satisfactory in most patients. During calcitriol treatment, plasma calcium concentration was significantly higher and serum parathyroid hormone concentration significantly lower than on placebo. There was no difference in the rates of development or of progression of vascular calcification in the two groups. Significantly more patients on placebo (17 vs. 6, p less than 0.05) developed a sustained elevation of plasma alkaline phosphatase concentration. Calcitriol appeared to protect against the development of histological evidence of osteitis fibrosa but not of osteomalacia, but accumulation of aluminum in bone occurred during the study. We conclude that calcitriol delays and may prevent the development of osteitis fibrosa in patients receiving regular hemodialysis and may reasonably be prescribed routinely in hemodialysis patients without biochemical or radiological abnormality, unless there is a substantial prospect of early renal transplantation.
Subject(s)
Bone Diseases/prevention & control , Calcitriol/therapeutic use , Renal Dialysis , Adolescent , Adult , Alkaline Phosphatase/blood , Bone Diseases/etiology , Bone Diseases/pathology , Bone and Bones/pathology , Calcinosis/prevention & control , Calcitriol/administration & dosage , Calcium/blood , Clinical Trials as Topic , Double-Blind Method , Humans , Middle Aged , Osteitis/prevention & control , Osteomalacia/prevention & control , Parathyroid Hormone/blood , Prospective Studies , Renal Dialysis/adverse effects , Time FactorsABSTRACT
Twenty-five men on maintenance hemodialysis commenced a placebo-controlled, double-blind, crossover trial of bromocriptine for erectile impotence. Eight patients on bromocriptine and one on placebo failed to complete the trial due to side-effects and 2 were withdrawn following renal transplantation. Libido or the frequency and/or quality of erections or both improved in 11 of the remaining 14 patients during bromocriptine treatment. A significant (P less than 0.01) improvement in patients' perception of sexual performance occurred on bromocriptine compared with placebo. The 3 patients in whom potency failed to improve had the lowest serum testosterone concentrations. Bromocriptine is usually effective in the management of impotence in males receiving maintenance hemodialysis provided pretreatment serum testosterone is above the lower end of the normal range, but side-effects are relatively common.
Subject(s)
Bromocriptine/therapeutic use , Erectile Dysfunction/drug therapy , Libido/drug effects , Renal Dialysis/adverse effects , Adult , Clinical Trials as Topic , Double-Blind Method , Humans , Male , Middle Aged , Testosterone/bloodABSTRACT
Seventy-six patients receiving regular haemodialysis, without biochemical or radiological evidence of renal osteodystrophy, entered a five-year double-blind placebo-controlled trial of calcitriol (1,25-dihydroxycholecalciferol) in the prevention of bone disease. Significantly more patients on placebo developed bone disease as judged by a sustained elevation of plasma alkaline phosphatase or the development of sub-periosteal erosions on hand radiographs. Serum parathyroid hormone fell significantly in the patients receiving calcitriol and was significantly lower than in patients receiving placebo. It is concluded that calcitriol delays and may prevent the development of metabolic bone disease in patients receiving regular haemodialysis therapy.
Subject(s)
Calcitriol/therapeutic use , Chronic Kidney Disease-Mineral and Bone Disorder/prevention & control , Renal Dialysis , Adolescent , Adult , Alkaline Phosphatase/blood , Calcium/blood , Clinical Trials as Topic , Double-Blind Method , Humans , Kidney Failure, Chronic/therapy , Middle Aged , Parathyroid Hormone/bloodABSTRACT
Cases of malaria caused by Plasmodium falciparum resistant to chloroquine treatment have been probably occurring in Vanuatu for many years. In this survey, seven patients with P. falciparum malaria were investigated for evidence of resistance to chloroquine. In-vitro resistance to chloroquine was demonstrated in four. Two further patients who had clinical resistance to chloroquine treatment developed cerebral malaria. It is of interest that one of these patients was subsequently successfully treated with mepacrine. Two additional cases are cited as examples of resistance to chloroquine treatment encountered in the past.
Subject(s)
Chloroquine/pharmacology , Malaria/parasitology , Plasmodium falciparum/drug effects , Adult , Brain Diseases/parasitology , Child , Drug Resistance, Microbial , Female , Humans , In Vitro Techniques , Malaria/drug therapy , Male , Quinacrine/pharmacology , Quinacrine/therapeutic use , VanuatuABSTRACT
Hypercalcaemia regularly occurs when "prophylactic" 1,25-dihydroxyvitamin D3 (1,25[OH)2D3) in a dose of 1.0 microgram daily is given to haemodialysis patients without clinical biochemical or radiological evidence of osteodystophy. This dose is too large for such patients. Hypercalcaemia may persist for several weeks after withdrawal of 1,25(OH)2D3, particularly when previous attempts at control by dosage reduction have failed. Hypercalcaemia is better managed by stopping 1,25(OH)2D3, albeit temporarily, than by reducing the dose.
