Background and Aims Hyperprolactinemia is a hormonal disorder associated with many diseases, including chronic kidney disease (CKD). Some studies have shown that serum prolactin (PRL) levels increase as CKD progresses, due to decreased renal clearance and increased production. This prolactin retention leads to inhibition of gonadotropic hormone production, and testosterone deficiency in male patients with CKD. Thus, this study aimed to evaluate PRL levels in male patients with different stages of CKD and its association with clinical and laboratory characteristics, strength, sexual dysfunction, and quality of life. Method This is a transversal study conducted in a tertiary hospital in southern Brazil. Patients with CKD stage IV and V were included and divided into three groups: 1) stage IV; 2) non-dialysis-dependent stage V and; 3) dialysis-dependent stage V (VD). Patients with prescribed hormone therapy were excluded. PRL, creatinine, testosterone, estradiol, albumin, SHBG, LH, and FSH levels were measured. Free testosterone was estimated by the Vermeulen equation. Patients were also evaluated for strength and musculoskeletal function through the “handgrip strength” test. For evaluation of the quality of life and sexual dysfunction, validated questionnaires were applied: AMS (Aging Male's Symptoms Scale), ADAM (Androgen Deficiency in the Aging Male) and SF-36 Health. Results In this study, 164 patients were included (IV=75; V=41; VD=48). The mean age was 64 [55-71] years and BMI 26,9 [23,3-30,04] kg/m2. The dialysis-dependent group had higher prevalence of hyperprolactinemia (22,6% vs. 49% vs. 66%, p<0,001), higher PRL (13,4 vs. 19,43 vs. 26,13, p<0,001) and estradiol (25,6 vs. 24,4 vs. 30,5, p=0,041). PRL levels were positive correlated with CKD stage (rs=0,482, p<0,001) and creatinine (rs=0,467, p<0,001) and negative correlated with testosterone (rs=-0,286, p<0,001) and free testosterone levels (rs=-0,307, p<0,001). There was no difference in PRL levels between hemodialysis and peritoneal dialysis (p=1,000). Analyzes related to the association of PRL levels with strength, quality of life, and sexual dysfunction are still being analyzed. Conclusion Hyperprolactinemia is associated with the severity of CKD, with a higher prevalence in dialysis patients. The relation of PRL levels with strength, quality of life, and sexual dysfunction are being evaluated.
Background and Aims Patients on renal replacement therapy (RRT) pose multiple risk factors that may increase the risk of death from coronavirus disease 2019 (COVID-19). Currently, evidence of incidence, management, and prognosis of COVID-19 in this population are scarce. Method Between May and December 2020, we followed two RRT populations that have the same tertiary hospital in Southern Brazil as its reference hospital for transplantation. Firstly, we monitored eight affiliated dialysis clinics keeping track of COVID-19 incidence and fatality rate in dialysis patients and those on the kidney transplant waiting list. In the same period, we also monitor COVID-19 incidence and mortality among our prevalent population of kidney transplant recipients. Results We evaluated 1049 patients in RRT in the dialysis centers. COVID-19 occurred in 89 of such patients (8.5%), and 31 died from such condition (35.8% death rate). Fifteen patients (5.45%), among 275 on the kidney transplant waiting list, contracted the virus, with one death (6.6%). Within our prevalent population of 1348 kidney transplant recipients, 113 were diagnosed with COVID19 (incidence: 8.4%), and 17 of them died (mortality rate: 15%). Finally, the number of kidney transplants decreased by 60.4% compared with the same period in the previous year. Conclusion COVID-19 determined a substantial impact on RRT. A high frequency of chronic dialysis patients expired from the disease. The impact on the patients on the transplant waiting list seems to be less pronounced probably due to their better health conditions. The fatality rate in kidney transplant recipients is elevated and probably mostly related to comorbidities. Brazil is currently entering the second wave of the disease and it is crucial to find and provide means to protect such vulnerable populations.
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