The use of androgens in anaemia resistant to erythropoietin and i.v. iron in patients with heart and renal failure

Sir,

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 EPO–Fe 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.

Donald Silverberg1, Dov Wexler2, Miriam Blum1, Doron Schwartz1 and Adrian Iaina1

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

References

  1. Navarro JF. In the erythropoietin era, can we forget alternative or adjunctive therapies for renal anaemia management? The androgen example. Nephrol Dial Transplant 2003; 18: 2222–2226[Free Full Text]
  2. Silverberg DS, Wexler D, Blum M, Schwartz D, Wollman Y, Iaina A. Erythropoietin should be part of the management of congestive heart failure management. Kidney Int 2003; 64 [Suppl 87]: S40–S47[CrossRef]
  3. Silverberg DS, Wexler D, Blum M, Iaina A. The Cardio Renal Anemia Syndrome: correcting anemia in patients with resistant congestive heart failure can improve both cardiac and renal function and reduce hospitalizations. Clin Nephrol 2003; 60 [Suppl 1]: S93–S102[Medline]
  4. Silverberg DS, Wexler D, Blum M et al. The effect of correction of anaemia in diabetic and non diabetics with severe resistant congestive heart failure and chronic renal failure by subcutanous erythropoietin and intravenous iron. Nephrol Dial Transplant 2003; 18: 141–146[Abstract/Free Full Text]
  5. Silverberg DS, Wexler D, Blum M et al. The use of subcutaneous erythropoietin and intravenous iron for the treatment of the anemia of severe, resistant congestive heart failure improves cardiac and renal function, functional cardiac class, and markedly reduces hospitalizations. J Am Coll Cardiol 2000; 35: 1737–1744[CrossRef][ISI][Medline]
  6. Silverberg DS, Wexler D, Sheps D et al. The effect of correction of mild anemia in severe resistant heart failure using subcutaneous erythropoietin and intravenous iron: a randomized controlled study. J Am Coll Cardiol 2001; 37: 1775–1780[CrossRef][ISI][Medline]




This Article
Extract
FREE Full Text (PDF)
Alert me when this article is cited
Alert me if a correction is posted
Services
Email this article to a friend
Similar articles in this journal
Similar articles in ISI Web of Science
Similar articles in PubMed
Alert me to new issues of the journal
Add to My Personal Archive
Download to citation manager
Search for citing articles in:
ISI Web of Science (1)
Disclaimer
Request Permissions
Google Scholar
Articles by Silverberg, D.
Articles by Iaina, A.
PubMed
PubMed Citation
Articles by Silverberg, D.
Articles by Iaina, A.