Prospective Controlled Study of Androgen Therapy in the Anemia of Chronic Renal Disease: Effects on Iron Kinetics

Solomon, Lawrence R.; Hendler, Ernesto D.

doi:10.1159/000205683

Cited by 13 publications

(5 citation statements)

References 28 publications

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“…In a subsequent small study using 59 FE and 51 Cr, these investigators examined the ferrokinetic effects of nandrolone decanoate (6). Androgen-treated patients experienced an increase in RBC mass without an increase in erythron iron turnover or a fall in marrow transit time.…”

Section: Mechanism Of Actionmentioning

confidence: 99%

Use of Androgens in Patients with Renal Failure

Johnson

2000

Seminars in Dialysis

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Anabolic steroids have been used for the treatment of the anemia of chronic renal failure for more than 25 years. Due to concerns over adverse effects, their use historically has been limited to nandrolone decanoate given to men, usually over age 50, who have intact kidneys. The introduction of epoetin alfa in 1989 has led to reduced androgen use for the treatment of anemia. Nevertheless, there continues to be scientific investigation into the possible role that androgens may play in combination with or as an alternative to erythropoietin. Whether combination therapy will prove to be useful remains to be determined in a large, prospective, randomized trial. There is little likelihood, based on present literature, that androgen therapy alone will replace epoetin alfa in U.S. dialysis units. This topic was addressed recently by the Anemia Work Group of the National Kidney Foundation Dialysis Outcomes Quality Initiative (27). While acknowledging androgen treatment may be less expensive than epoetin alfa, the group stated that the potential risks of primary androgen therapy alone make this form of treatment "unacceptable." The work group did not offer any recommendations on the combined use of erythropoietin and androgens, stating that published data are inconclusive. If future reimbursement policies are changed to include epoetin alfa within a capitated rate, economic incentives may lead to increased use of androgens to achieve targeted hematocrit values. The potential value of anabolic steroids for treating malnutrition in dialysis patients is an intriguing idea. Very little has been done to explore this issue, and this clinical practice has not become widespread nor universally recommended (28). Prospective clinical trials in this area may be warranted as well.

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Section: Mechanism Of Actionmentioning

confidence: 99%

Use of Androgens in Patients with Renal Failure

Johnson

2000

Seminars in Dialysis

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“…One limitation is the fact that the findings are not generalizable to all patient populations with CKD. Two of the four studies included in this meta-analysis had only male patients over the age of 50, likely because response to androgens has previously been shown to be age related [13] and because of the risk of virilization in females. Androgens may be more effective in older males because of testosterone deficiency in these patients.…”

Section: Discussionmentioning

confidence: 99%

Meta-Analysis of Randomized Controlled Trials on Androgens versus Erythropoietin for Anaemia of Chronic Kidney Disease: Implications for Developing Countries

Adamu

Ma'aji

Erwin

et al. 2012

International Journal of Nephrology

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Androgens which are relatively cheap were used in the treatment of anaemia in dialysis patients before the advent of Erythropoietin (EPO). However, there are concerns about their efficacy and side effects. Aims. To examine the efficacy and harms of androgens for the treatment of anaemia of chronic kidney disease (CKD) compared to EPO. Settings and Design. A systematic review and meta-analysis using an a priori protocol. Methods and Materials. We searched several databases for randomized controlled trials using the key terms anaemia, chronic kidney disease, and androgens, without language restrictions. We also searched reference lists of relevant articles. Statistical Analysis Used. Data was analyzed using Review manger 5 software. We summarized treatment effects as relative risks and mean differences, with 95% confidence intervals using a random-effect model. We tested for heterogeneity with Chi2 and the I2 statistics. Results. We identified four eligible trials involving 114 participants, majority (83.33%) of whom were males, mostly over 50 years of age. The pooled difference in mean haemoglobin between the nandrolone and EPO arms at the end of the trials was −0.11 (CI −0.80 to 0.58) which is not statistically significant. Conclusions. This meta-analysis revealed no difference between nandrolone and EPO for the treatment of anaemia of CKD in men over 50 years. Therefore, nandrolone can be used for the treatment of anaemia of CKD in this category of patients, in resource-limited countries. However, further studies are needed to determine the long-term safety of nandrolone in men over 50 years old, as well as its effectiveness and safety in females in general, and males less than 50 years of age.

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“…It has been proposed that the intimal mechanism may be mediated by triggering the pluripotential stem cells from the G 0 phase or prolonged G 1 phase into a G 1 interval responsive to EPO (83). Furthermore, the works by Solomon and Hendler based on ferrokinetic data and RBC enzyme determinations (50,51) showed that the increase in RBC mass after administration of ND resulted from two mechanisms: increased erythropoiesis, shown by simultaneous increases in RBC mass and erythron iron turnover; and also increased RBC survival, suggested by an increase in RBC mass without increment in erythron iron turnover.…”

Section: Androgens and Renal Anemiamentioning

confidence: 99%

Effect of Androgens on Anemia and Malnutrition in Renal Failure: Implications for Patients on Peritoneal Dialysis

Navarro

Mora

2001

Perit Dial Int

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Objective To analyze the implications of the potential use of androgens in peritoneal dialysis patients, focusing on their effects on hematologic and nutritional parameters. This manuscript reviews the different compounds for clinical use, dosage schedules, adverse effects, and how therapy with androgens might be used to treat anemia and malnutrition in these dialysis patients. Data Sources Studies in the literature dealing with the effects of androgens on hematologic and nutritional parameters, and their role in uremic anemia and malnutrition. Study Selection Studies in which uremic patients received androgens as therapy for anemia or malnutrition. Data Extraction Data were abstracted from all of these studies. Results This review shows that androgens are anabolic substances that also have significant actions on erythropoiesis. A number of clinical studies in uremic patients have found that these compounds have beneficial effects on hematologic parameters and nutritional status, similarly to other therapies, such as recombinant human erythropoietin and recombinant human growth hormone, respectively. Conclusions Androgens have been shown to have a beneficial effect on anemia due to renal disease and on nutritional status in uremic patients. Further studies need to be done with larger groups of patients. Objectives for additional research are suggested.

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Prospective Controlled Study of Androgen Therapy in the Anemia of Chronic Renal Disease: Effects on Iron Kinetics

Cited by 13 publications

References 28 publications

Use of Androgens in Patients with Renal Failure

Use of Androgens in Patients with Renal Failure

Meta-Analysis of Randomized Controlled Trials on Androgens versus Erythropoietin for Anaemia of Chronic Kidney Disease: Implications for Developing Countries

Effect of Androgens on Anemia and Malnutrition in Renal Failure: Implications for Patients on Peritoneal Dialysis

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