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J Puka

Publications and source records attributed to J Puka.

10 recordsLinked to original sources
PubMed1999

The benefits of hormone replacement therapy in pre-menopausal women with oestrogen deficiency on haemodialysis.

BACKGROUND: Impaired sexual function is an important cause of depression in uraemic females. Hyperprolactinaemia is frequent, and often associated with decreased serum oestradiol concentration, which can significantly contribute to accelerated bone loss. The aim of the study was to evaluate the effect of hormone replacement therapy (HRT) on sexual function, serum 17beta-oestradiol and prolactin, and bone mineral density (BMD) in pre-menopausal women undergoing haemodialysis. METHODS: Among 63 women on haemodialysis, aged 18-45 years, 23 with secondary amenorrhoea and serum oestradiol < 30 pg/ml were enrolled into the 1 year study. They were divided into: group I (n = 13) treated with transdermal oestradiol with cyclic addition of noretisterone acetate, and control group II (n = 10). BMD was measured with dual energy X-ray absorptiometry (DEXA). RESULTS: No important changes in sexual function and hormonal profile were observed in the control group, whereas in all women from group I the treatment induced regular menses and a marked improvement of libido and sexual activity. Serum 17beta-oestradiol increased after the first month from 20.5 +/- 11.7 to 46.8 +/- 13.6 pg/ml (P < 0.001) and remained at that level until the end of the study, accompanied by a decrease of serum prolactin (from 1457 +/- 1045 to 691 +/- 116 mIU/ml after 12 months; P < 0.001). In group I, the treatment induced an increase in BMD, although significant only in L2-L4 (P < 0.05), whereas in group II a mild insignificant decrease was observed. However, a comparison of BMD values after 12 months in both groups revealed marked (P < 0.01-P < 0.05) differences at all studied sites. CONCLUSIONS: Transdermal HRT allows sustained physiological serum oestradiol concentrations in pre-menopausal women with oestrogen deficiency on haemodialysis, with the restoration of regular menses and a marked improvement in their sexual function. The treatment inhibits bone demineralization and can play an important role in the prevention of early osteoporosis in this group of patients.

Adolescent↗
PubMed1999

[The prevention of bone mineral loss with hormonal replacement therapy in premenopausal women on dialysis with estrogen deficiency].

In 25-30% of premenopausal dialysis women low serum estrogen concentrations are observed. This "premature menopause" can significantly contribute to accelerated bone loss. The aim of the study was to evaluate the effect of estrogen-gestagen replacement therapy on bone mineral density (BMD) in hemodialysis women with secondary to uremia estrogen deficiency. Among 20 hemodialysis women, aged 18-45 years, with serum 17 beta-estradiol < 30 pg/ml, ten (group I) received transdermal estradiol with cyclic addition of noretisterone acetate (Estracomb TTS 50/0.25), and another ten formed the control group (group II). BMD was evaluated by dual photon x-ray absorptiometry (DEXA, Lunar) in: lumbar spine (L2-L4), 1/3 distal radius and femoral neck, before and after the study. Serum 17 beta-estradiol concentrations were measured before, and after 1, 3, 6 and 12 months of the study. After one year, in group I, in which serum 17 beta-estradiol normalized already during the first month (p < 0.001), an increase of in BMD was noted, although significant only in L2-L4 (p < 0.05). In group II, no change in serum 17 beta-estradiol and mild but insignificant decrease in BMD were observed. However, a comparison of BMD values after 12 months in both groups revealed the marked differences in all studied sites (p < 0.01, p < 0.02, p < 0.05 in L4-L2, distal radius and femoral neck, respectively). The mean serum calcium, phosphate, PTH and alkaline phosphatase activity were similar in both groups and did not change during the study. In premenopausal hemodialysis women with estrogen deficiency, hormonal replacement therapy inhibits bone demineralization and can be useful in prevention of early osteoporosis.

Adolescent↗
PubMed1996

[Long-term treatment with large doses of alphacalicidol in secondary hyperparathyroidism of patients dialyzed for end stage renal failure].

The purpose of the study was to evaluate the effectiveness of the long-term oral pulse therapy with high doses of alphacalcidol (1 alpha (OH)D3) in severe uremic hyperparathyroidism. 43 hemodialysis patients with at least 5-fold 1-84 PTH serum elevation were given thrice a week oral (1 alpha (OH) D3) in doses up to 5 micrograms, according to serum calcium levels (monitored weekly). The drug was given in the evenings (Group A; 18 pts) or during hemodialysis sessions (Group B; 25 pts). The dialysate calcium was reduce to 1.40-1.45 mmol/l and CaCO3 was used as a main phosphate binder in doses up to 6 g/day; 13 pts received additionally small doses of Al (OH)3 (up to 3 g/day). After one month the PTH levels decreased by 67 +/- 7.7% (p < 0.001), while serum total calcium increased by 0.27 < or = 0.05 mmol/l. The parathyroid activity suppression progressed to 81 +/- 6.9% serum PTH reduction after 4 months and 74 +/- 6.1% fall after 8 months. Only 3 pts occurred to be non-responders; in 19 pts PTH levels normalized. A decrease of serum hydroxyproline and alkaline phosphatase with its bone isoenzyme activity was also observed with a direct correlation between those changes and parathyroid suppression. (1 alpha (OH) D3) dose at first month of therapy was 3.4 +/- 0.15 micrograms, but it was successively reduced because of hypercalcemia to a final dose of 2.2 +/- 0.22 micrograms. The frequency of hyperkalcemia was 7.6%; no difference between Group A and group B was noted. We conclude that oral (1 alpha (OH)D3) pulse therapy is very effective in the long-term parathyroid activity suppression in hemodialysis patients with severe hyperparathyroidism. To avoid dangerous hypercalcemia and relative hypoparathyroidism serum PTH and calcium levels should be carefully monitored.

Administration, Oral↗
PubMed1996

[Combined therapy with calcitonin and high doses of active vitamin D3 metabolites in uremic hyperparathyroidism].

Active vitamin D3 pulse therapy effectively suppresses parathormone (PTH) synthesis in uremic hyperparathyroidism but high serum levels of calcitriol achieved can induce direct osteoclastic resorption and block bone formation. Therefore we found it interesting to examine whether an addition of the osteoclast inhibitor, calcitonin (CT), could reduce those unwanted effects. 75 hemodialysis patients with at least 5-fold 1-84 PTH serum level elevation were divided into 4 treatment groups: I (n = 19)-CT and 1 alpha-OH-D3; II (n = 20)-CT; III (n = 19)-1 alpha-OH-D3 (n = 10) or 1.25 (OH)2D3 (n = 9) alone; IV (n = 17)-none of these drugs. CT (200 IU) and 1 alpha-OH-D3/1.25(OH)2D3 (up to 5 micrograms) were given 3 times a week. Dialysate Ca was 1.40-1.45 (Group I, III) or 1.95-2.00 mmol/l (Group II, IV). Within 8 months serum 1-84 PTH fell by 75% (p < 0.001) in Group I and by 77% (p < 0.001) in Group II, serum Ca increased by 0.22 +/- 0.05 mmol/l in Group I (p < 0.005) and by 0.25 +/- 0.05 mmol/l in Group III (p < 0.005), alkaline phosphatase activity decreased by 35% in Group I (p < 0.01) and 31% in Group III (p < 0.005) whereas in Groups II and IV no significant changes were noted. In Group III no differences between patients taking 1 alpha-OH-D3 or 1.25 (OH)2D3 were observed. The significant reduction of serum hydroxyproline (37%; p < 0.001) was seen only in Group 1. The increase in bone mineral density (BMD) measured by dual-energy X-ray absorptiometry was greater in Group I than in Group III (p < 0.05). In Group II the effect was mostly insignificant, whereas in Group IV a substantial decrease (p < 0.001) in BMD was observed. These data suggest that combined therapy with CT and oral 1 alpha-OH-D3 pulses is more effective than pulses alone in inhibiting bone resorption and in increasing BMD in hemodialysis patients with uremic hyperparathyroid bone disease.

Adult↗
PubMed1994

[Development of dialysis therapy in Poland during the decade 1984-1993].

Data concerning status of dialysis therapy in Poland during decade 1984-1993 were analysed. It was found that: 1. number of dialysis units increased two times (54-105), 2. number of dialysis stations raised 2.5 times (294-812), 3. number of patients treated with maintenance dialysis was increased 3.5 times (962-3783). These data showed dynamic development of this method of renal replacement therapy in Poland. However, in Poland acceptance rate dto dialysis therapy is still not satisfactory (30-35%). The Programme of the Country Committee for the Promotion of Nephrology based on the central founding system for the renal replacement therapy provides that by the end of 1995 it will be possible to treat 50% of patients with chronic uraemia. Continuous development of different methods of renal replacement therapy (hemodialysis, continuous ambulatory peritoneal dialysis, renal transplantation) is necessary for achieving possibilities compared with developed countries.

Health Promotion↗