HDCN Article Review/Hyperlink

Teruel JL, Marcen R, Navarro-Antolin J, Aquilera A, Fernandez -Juarez G, Ortuno J

Androgen versus erythropoeitin for the treatment of anemia in hemodialyzed patients: a prospective study

J Am Soc Nephrol (Jan) 7:140-144 1996

Prior to the introduction into clinical practice of recombinant human erythropoietin (rHuEPO), androgen therapy was occasionally used in the treatment of the anemia of end-stage renal disease. The anabolic effects of androgens lead to an increase in red cell mass. Previous studies have yielded inconsistent results regarding the efficacy of this therapy.These authors have previously observed androgens to be safe and effective in older men. The purpose of the current study was to compare androgens to rHuEPO in the therapy of anemia in ESRD. Eighteen men selected on the basis of being more that 50 years old were treated with nandrolone decoanate (200 mg IM/week) for 6 months. Twenty-two men less than 50 years old and women were treated with rHuEPO with dose titrated to achieve a hemoglobin level of 10-11 g/dl. Both groups had significant increases in hemoglobin; androgen group from 7.3+/- 0.8 to 10.8 +/- 1.7, rHuEPO group from 7.0 +/-0.6 to 10.4 +/- 1.0. There was no statistically significant difference between the responses in the two groups. Hypertensive control worsened in the rHuEPO group in 45% of patients, compared to 6% in the androgen group. Patients in the androgen group had significant increases in serum albumin, dry weight, and serum triglyceride levels.

Comment: This is an interesting example of the current interest in finding less expensive alternatives to rHuEPO therapy. The authors have shown in a small group of patients that androgens were as effective in older men, as rHuEPO was in women and younger men. An obvious concern with this study design is that the populations studied were different. Ideally, a randomized approach, in which men greater than 50 years old received either androgens or rHuEPO would have provided a more satisfying answer to the research question. Nonetheless, we should not discount the importance of these findings. If older men were known to have a greater erythropoietic response than women or young men, then the results of this study would be vitiated. There is no known difference in reponse, therefore, I believe the study results are probably valid. Confirmation in a larger trial, using a randomized study design would be helpful. The anabolic effects of androgens would probably be beneficial in older hemodialysis patients, and the increase in triglycerides should not be clinically important. (Steven Fishbane MD, Winthrop- University Hospital, Mineola, NY)