The Efficacy and Safety of Desmopressin in the Treatment of by mikeholy

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									The Efficacy and Safety of Desmopressin
  in the Treatment of Elderly Patients
  with Nocturia for 13month Follow-up


   Shim KS, Park HS, Lee JG, Kim JJ, Moon DG
            Department of Urology
      Korea University College of Medicine
 Antidiuretic hormone in elderly male patients with severe nocturia:
 a circadian study. BJU Int. 2004 Sep;94(4):571-5.
 Presented by Podium at AUA, 2003, Chicago

• Group I (n=12)                    • 24-hour circadian studies during a 72-
                                      hour admission.
  - Male pts > 60 yrs
  - Nocturia > 3 per night          • At every 3 hour from 1st day 11:00 pm to
                                      3rd day 5:00 pm
• Group II (n=5)                       – Serum chemistry
   - Age matched normal control        – Timed Urine study
                                       – Vassopressin (RIA)
• Exclusion criteria
                                    • In Group 1 of nocturia patients,
• Behaviour modification              DDAVP 0.2mg, p.o, at 10:00 pm of 2nd
                                      day
• Basal study                          – Urinary volume
    Voiding diary, UDS, BPH study      – Serum, Urinary chemistry
                                       – Vassopressin (RIA), DDAVP(RIA)
Antidiuretic hormone in elderly male patients with severe nocturia: a circadian
study. BJU Int. 2004 Sep;94(4):571-5.
Presented by Podium at AUA, 2003, Chicago


    Circadian variation of ADH and concentration of
    DDAVP after oral administration
                                2.5


                                 2
        Concentration (pg/mL)




                                                                           ADH in
                                1.5                                        Normal
                                                                           ADH in
                                                                           Nocturia
                                 1                                         DDAVP


                                0.5


                                 0
                                      11PM   2AM   5AM   8AM   2PM   8PM
Antidiuretic hormone in elderly male patients with severe nocturia: a circadian study.
BJU Int. 2004 Sep;94(4):571-5.
Presented by Podium at AUA, 2003, Chicago
Changes of significant parameters after administration of DDAVP

                               Pre-DDAVP                 Post-DDAVP
                                            Serum
    Na(mmol/L)                 138.86                    136.11**
    K(mmol/L)                  4.35                      4.89*
    Cl(mmol/L)                 105.02                    101.91**
                                            Urine
    Vol+(mL)                   709.2±366.25             472.5±251.33**
    Na(mmol/L)                 139.13                   189.91*
    Cl(mmol/L)                 125.07                   173.6*
    Osm                        556.92                   668.42*
    +: night time urine vol.(11pm-8am), * p<0.05, ** p<0.01
The Efficacy and Safety of Desmopressin in the Treatment
of Elderly Patients with Nocturia for 13-month Follow-Up.
Submitted for presentation at AUA, 2006, Atlanta

• 15 Male pts, nocturia > 3 per night

• 0.2mg, DDAVP at bedtime, every day for 1 year.

• Before and 1 month after 1-year medication, 24-hour
  circadian during a 72-hour admission.

• At every 3 months during medication, serum and timed urine
  chemistry
    Patients
• Group I (n=15)                   • Behaviour modification
    - Male pts > 60 yrs              - night-time water restriction
    - Nocturia > 3 per night
•   Group II (n=5)
    - Age matched normal control   • Basal study
• Exclusion criteria                  –   Voiding diary
    - Cardiovascular disease          –   UDS
    - Renal insufficiency             –   BPH study
    - Hepatic insufficiency
    - Uncontrolled diabetes        • 24-hour circadian studies
    - Urinary tract infection        during a 72-hour admission.
    - Neurogenic bladder pts.
Assessment

• At every 3 hour from 1st day 11:00 pm to 3rd day 5:00 pm

   – Urinary volume
   – Serum chemistry
   – Urinary chemistry
   – Vassopressin (RIA)
Results

                           Nocturia pts            Normal control
 No. pts                   15                      5
 Mean age (yrs)            71.4                    64.5
 Volume of prostate (cc)   31.7±15.63              23.1 ±15.63
 PSA (ng/ml)               2.18±1.76               1.93 ±0.51
 IPSS                      15.67±5.19              -
 Nocturnal polyuria (%)    53.3 (8/15)             -
 UDS                       BOO: 5
                           Det. overactivity: 2
                           Det. underactivity: 2
      Table. Significant variables before and every 3 months and
                 1 month washout after 1 year medication with DDAVP
        Mean±SD                   Before             3mon.             6mon.           9mon.        12mon.       13mon.‡

      Total urine
      output (mL)               1719±198          1644±222          1768±775         1496±588     1495±394      1724±613
Noctunal urine output
       (mL)                     647±252            498±268           481±304          430±510      441±308*      751±415†
    No. of nocturia             4.85±0.93         1.11±1.36         1.89±0.93        1.88±0.83    1.43±0.79*    3.14±1.07†

  Sleeping time (min)          400.0±36.9         394.3±66.3        421.4±47.0       439.4±59.6   427.2±55.7    414.7±48.6

 1st voiding time (min)        125.8±13.7         265.8±35.1        291.1±45.7       322.8±64.3   312.5±58.7*   155.5±47.1†

       QoL (0-6)                 5.5±0.52          2.1±0.97          1.7±0.58         1.9±0.65     1.5±0.82*     5.3±0.43†

  Serum Na (mmol/L)             142±1.94           140±1.70          139±2.04        139±2.54     136±4.27*     139±1.05†

  Urine Na (mmol/L)             186±81.1           203±49.4          170±64.5        190±82.6      209±63.7      157±65†

    Urine osmolality            496±119            505±165           434±138          516±158      513±157      390±79.3†
      (mOsm/Kg)


*: stastistically significant (before vs 12mon)
†: stastistically significant (12mon vs 13mon)    ‡: 1 month after stop medication
Sequential changes of Serum Na
             145


             140
  Serum Na




                                                          Pt. 11
             135                                          Pt. 13
                                                          AVR

             130


             125
                   0 M   3 M   6 M    9 M   12 M   13 M
                                  Time
Circadian variation of ADH

                               2 .5
                                                                           Premedication
                                                                           After washout
                                 2
       Concentration (pg/mL)




                               1 .5




                                 1




                               0 .5




                                 0
                                      1 1 pm   2 am   5 am          8 am   2 pm    5 pm
                                                             Time

								
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