We read with interest the recent thorough review of use of androgen therapy in the management of renal anaemia [1]. We have been interested in the role of erythropoietin and i.v. iron in the correction of the anaemia seen in patients with congestive heart failure (CHF) [26]. Most of these patients also have chronic kidney insufficiency (CKI). In 223 such cases, we attempted to correct their anaemia with the combination of up to 10 000 IU erythropoietin (EPO) given subcutaneously once weekly, and i.v. Venofer (ferric sucrose) given once weekly. We gave the Venofer until either the haemoglobin (Hb) reached target, the per cent transferrin saturation reached 35% or the serum ferritin reached 700 ug/l, whichever came first. We encountered 19 cases (8.5%) (mean age 74.0±6.9 years) (14 males/five females) that failed to reach a target Hb of 13 g/dl over at least 4 months of this treatment, the Hb increasing from a mean of 10.1±1.2 to 11.1±0.8 g/dl. In these 19 cases we administered nandrolone decanoate (ND) 200 mg (one ampoule) once weekly i.m. while continuing the EPOFe combination until the target Hb was reached. One male patient developed a skin rash within 24 h after the first dose and was removed from the study. In the remaining 18 cases the mean Hb increased over the next 3 months from 11.1±0.8 to 13.3±0.8 g/dl (P<0.01). All the patients reached the target Hb by 3 months after ND treatment was started. None of the 18 patients, male or female, complained of any side effects and most noted an increase in appetite. There were no significant changes in serum cholesterol, HDL, LDL, triglycerides, liver function tests or blood pressure. Subsequently the patients no longer required further ND and were maintained on EPO and i.v. Fe as needed. We agree with Navarro that in patients with anaemia and CKI who do not reach target Hb with large doses of EPO and i.v. Fe the short-term addition of ND may rapidly correct the anaemia with minimal side effects. ND seems to be a useful adjuvant in patients receiving EPO for the correction of the anaemia of renal and heart failure who are resistant to therapy.
Conflict of interest statement. None declared.
1Tel Aviv Sourasky Medical Center Department of Nephrology Tel Aviv 2Tel Aviv Sorasky Medical Center Department of Cardiology Tel Aviv Israel Email: donald{at}netvision.net.il
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