Intermittent Hormonal Therapy for PCa May Have Benefits

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					Lit review0609.qxp    6/1/09    11:20 AM     Page 1




      30 Renal & Urology News                  JUNE 2009




                                                             WORLD LITERATURE REVIEW



           Hip Fracture-Related Death                                                                                                     Fernando E.C. Calais da Silva, MD,
           Linked to CKD in the Elderly                                                                                                 of Centro Hospitalar de Lisboa
           Nephrol Dial Transplant. 2009;24:1539-                                                                                       Central in Lisbon, and colleagues
           1544                                                                                                                         recruited 766 men with locally
                                                                                                                                        or advanced prostate cancer who


           A
                       mong older individuals,                                                                                          received an initial three-month in-
                       an estimated glomerular                                                                                          duction treatment. During induc-
                       filtration rate (eGFR)                                                                                           tion, all subjects received cypro-
           below 45 mL/min/1.73 m2 is as-                                                                                               terone acetate (CPA) 200 mg for
           sociated with a nearly twofold                                                                                               two weeks and then monthly depot
           increased risk of hip-fracture-                                                                                              injections of a luteinizing hormone-
           related mortality, according to                                                                                              releasing hormone (LHRH) analog
           British researchers.                                                                                                         plus 200 mg of CPA daily. After
             Dorothea Nitsch, MD, MSc, of             that their results are based only on     patients after HD initiation. These      three months, the 626 patients
           the London School of Hygiene &             mortality and not on the incidence       two subgroups had similar sur-           who experienced a decline in PSA
           Tropical Medicine in the U.K., and         of hip fracture. In addition, they did   vival, which was significantly worse     level to less than 4 ng/mL or to
           colleagues studied 13,167 patients         not have a direct measure of true        when compared with subjects              80% below the initial value were
           aged 75 years and older (5,111 men         kidney function.                         without PHT.                             randomized to receive intermit-
           and 8,056 women) who had serum                                                        In multivariable analysis, devel-      tent (314 patients) or continuous
           creatinine levels measured at base-        Pulmonary Hypertension in HD             opment of PHT before and after           treatment (312 patients). The in-
           line. Eighty-four deaths related to        Patients Increases Death Risk            the start of HD was independently        termittent arm ceased treatment
           hip fracture occurred over a medi-         Kidney Int. 2009;75:969-975              associated with a 3.6 and 2.1 times      whereas the continuous arm re-
           an follow-up of 7.25 years. Subjects                                                increased risk of death, respective-     ceived 200 mg CPA daily plus an


                                                      I
           with an eGFR below 45 were at                  israeli researchers report that      ly, compared with patients who did       LHRH analog.
           1.81 times higher risk of hip-                 pulmonary hypertension (PHT)         not have PHT.                              In the intermittent arm, 127 men
           fracture-related death compared                independently predicts high-                                                  progressed and 170 died; in the
           with those with a higher eGFR,             er mortality in hemodialysis (HD)        Intermittent Hormonal Therapy            continuous arm, 107 progressed and
           
				
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