Effects of adjuvant androgen on anemia and nutritional parameters in chronic hemodialysis patients using low-dose recombinant human erythropoietin

Lee, Myeung Su; Ahn, Seon Ho; Song, Ju Hung

Abstract

BACKGROUND
Recombinant human erythropoietin (rHuEPO) has become attractive option of anemia therapy in chronic hemodialysis patients, but the use of rHuEPO is primarily limited by its high cost. So, the current cost-containment policy renders valuable any strategies that enhances the erythropoietic response to rHuEPO, thus resulting in lower rHuEPO dosing. Before the widespread availability of rHuEPO, androgen was the mainstay of nontransfusional therapy for the anemia of end-stage renal failure. However, previous studies that used androgen to enhance the response to rHuEPO showed variable results.
METHODS
We carried out a prospective study to examine the effect of adjuvant androgen on anemia and nutritional parameters in chronic hemodialysis patients using low-dose rHuEPO. Studies were performed in seventeen hemodialysis patients previously treated with low-dose rHuEPO (1,000 U rHuEPO subcutaneously three times a week), mean hemoglobin < 9.0 g/dL for 6 months (group A: before adjuvant androgen therapy). Same patients received the same dose of rHuEPO plus nandrolone decanoate 100 mg intramuscularly weekly for 6 months (group B: after adjuvant androgen therapy).
RESULTS
Transferrin saturation, serum ferritin, intact serum parathyroid hormone, plasma aluminium, ALT, ESR, albumin, PCRn and Kt/V were not significantly changed before and after adjuvant androgen therapy. The increase in hemoglobin and hematocrit in the group B was statistically greater than in the group A, respectively (8.99+/-1.39 g/dL vs 7.75+/-0.90 g/dL; p=0.001, 26.66+/-3.91% vs 23.68+/-2.85%; p= 0.003, respectively). With the exception of mild discomfort at the injected site, there were no significant side effects from nandrolone decanoate.
CONCLUSION
Adjuvant androgen in patients treated with low-dose rHuEPO is effective treatment for the anemia of poor responsive patients to low-dose rHuEPO and lower the economical cost compared with the higher dose rHuEPO treatment alone.