Effects of Adjuvant Androgen on Anemia and Nutritional Parameters in Chronic Hemodialysis Patients Using Low-dose Recombinant Human Erythropoietin

BACKGROUND: Recombiant human erythropoietin (epoetin) has greatly contributed to improvement of the anemia of chronic renal failure patients on hemodialysis. However, the reduced erythropoietic effect to epoetin and its high cost have induced lots of supplementary treatments. Therefore, we performed a prospective study to evaluate the effects of adjuvant low-dose androgen therapy in patients using a lower-dose of epoetin than the commonly recommended dose on anemia and the nutritional parameters. METHODS: 17 patients of hemoglobin (Hgb) less than 9 g/dL even after being treated with 1,000 U epoetin subcutaneously (s.c.) 3 times per week on a stable status for more than 6 months, who were on hemodialysis at our institution were examined. They were injected with the same dose of epoetin s.c. and nandrolone decanoate 100 mg intramuscularly (i.m) weekly for another 6 months. Blood test was performed every month before therapy for 6 months and after therapy for 6 months and the mean values were reviewed for comparison. RESULTS: Hgb (7.75+/-0.9 vs 8.99+/-1.39 g/dL, p < 0.01) and hematocrit (Hct) (23.68+/-2.85 vs 26.66+/-3.91%, p < 0.01) were apparently changed before and after adjuvant therapy. Hgb and Hct, weekly dose of epoetin were not statistically different in 9 male patients before and after adjuvant therapy. The weekly dose of epoetin was not statistically different in 8 female patients, but Hgb and Hct (8.02+/-0.6 vs 9.72+/-1.31 g/dL, 24.54+/-1.7 vs 28.74+/-3.06%, p < 0.01) were statistically different before and after adjuvant therapy. In comparison between male and female groups, weekly doses of epoetin and nandrolone decanoate were significantly greater in the female group than the male group (epoetin; 50.66+/-6.23 vs 61.18+/-8.76 U/kg/week, nandrolone decanoate; 1.69+/-0.2 vs 2.04+/-0.29 mg/kg/week, p < 0.05). CONCLUSION: Our data show that the adjuvant androgen therapy is effective for the anemia of hemodialysis patients who did not recover from anemia even after being continuously treated with low-dose epoetin.

Effects of Low-dose Androgen in Combination with Subcutaneous Recombinant Human Erythropoietin (r-HuEPO) on Anemia and Nutritional Parameters in Hemodialysis Patients / 대한신장학회잡지

Recombinant human erythropoietin(r-HuEPO) is the mainstay of anemia therapy in patient with end stage renal disease(ESRD), but the use of r-HuEPO is primarily limited by its high cost. So, it encourages any strategies that potentially enhance the erythropoietic response. However, studies designed to assess whether androgens would enhance the response to r-HuEPO were inconclusive. While androgens may be less expensive and may improve several nutritional parameters, their potential adverse effects discourage usage. We carried out a prospective study to examine the effect of low-dose androgen in combination with subcutaneous r-HuEPO on anemia and nutritional paramenters in hemodialysis patients. Twenty-four hemodialysis patients with hematocrit <24% or hemoglobin <8.0g/dL were randomly assigned into two groups. Group A(n=12) received 2000U r-HuEPO subcutaneously twice a week for six months. Group B(n=12) received the same dose of r-HuEPO plus nandrolone decanoate 100mg intramuscularly biweekly. Anthropometry, albumin, cholesterol, prealbumin, and transferrin were measured as nutritional parameters. The groups showed no differences in baseline levels of the followings : Hemoglobin, hematocrit; transferrin saturation; serum ferritin; intact serum parathyroid hormon, Kt/V; vitamin B12, folate; nutritional parameters. At the completion of the study, both groups showed significant increase in hematocrit compared with baseline levels(group A 20.7+/-2.2% to 26.0+/-3.8%; group B : 21.5+/-3.5% to 30.1+/-2.8%). The mean hematocrit in group B was significantly higher than in group A after 4 month study period(p<0.05). Ten of 12 patients in group B achieved a target hematocrit of 30%, as compared with four of 12 patients in group A. Both groups didn't show significant changes in any nutritional parameters. No significant side effects of androgen were noted during this short-term study. We conclude that low-dose androgen in combination with subcutaneous r-HuEPO is effetive treatment on anemia in hemodialysis patients, but does not improve nutritional status.

Efficacy of low dose recombinant human erythropoietin treatment in patients with pre-dialysis chronic renal failure / 대한내과학회지

BACKGROUND: Anemia is a most common complication of chronic renal failure and erythropoietin has proven to be a effective treatment for anemia in dialysis patient. However, in patients with pre-dialysis chronic renal failure, Use of erythropoietin is usually limited because of its high cost and frequent administration. The purpose of this study was to evaluate the efficacy of low dose erythropoietin treatment in patient with pre-dialysis chronic renal failure. METHODS: We administered erythropoietin 2000U weekly to 25 patients with pre-dialysis chronic renal failure untill hemoglobin and hematocrit reached to 11g/dl, 33% respectively. After then we administered erythropoietin 1000U weekly as a maintenance dose. We measured the level of hemoglobin, hematocrit, reticulocyte count, serum creatinine, BUN, serum iron, ferritin, total iron binding capacity every two weeks for 12 months. RESULTS: 1) In 25 patients treated for 16 weeks, hemoglobin and hematocrit level increased from 8.2g/dl,24.2% to 8.8g/dl,28.2%(p< 0.05) respectively. After 28 weeks treatment, 23 patients(92%) reached target hemoglobin and hematocrit value(11g/dl,33%). 2) Serum iron level increased from 180.2ug/dl to 165.1ug/dl(p< 0.05) after 16 weeks treatment. But there were no significant changes in serum ferritin and total iron binding capacitiy. 3) There was no significant change in reciprocal serum creatinine value before and after erythropoietin treatment. 5) There was no significant side effect except mild exacerabation of hypertension(2 cases) during erythropoietin treatment. CONCLUSION: This result show that relatively low dose erythropoietin treatment in patient with pre-dialysis chronic renal failure can be used as a effective treatment for anemia despite of slow and gradual response.