Androgen therapy for anaemia of chronic renal failure. Indications in the erythropoietin era.

The high cost of recombinant human erythropoietin has led us to consider the existing indications for androgen treatment of anaemia in patients with chronic renal failure. In the present work, we have tried to identify those patients on haemodialysis for whom androgens could constitute a therapeutic alternative. The evolution of haemoglobin concentration was analysed in 84 patients (67 males and 17 females) treated with a cycle of nandrolone decanoate (200 mg per week given intramuscularly, for six months). In the total group of patients, haemoglobin rose from 69 g/L to 87 g/L (p < 0.01). The increment in haemoglobin was not related to sex, basal haemoglobin, primary renal disease, or dose of nandrolone decanoate corrected by body weight. However, we observed a relationship between this increment in haemoglobin and patient age. Haemoglobin increased by 8 g/L in patients younger than 46 years (n = 29), by 18 g/L in patients aged between 46 and 55 years (n = 28), and by 27 g/L in patients older than 55 years (n = 27) (p < 0.01 between groups). In the last group, haemoglobin concentration at the end of androgen treatment was 101 +/- 16 g/L. The haemoglobin level reached during androgen treatment was maintained for over a year after androgen withdrawal in 55% of the responder patients. A reversible rise in the serum concentration of triglycerides was the main side-effect observed. Nandrolone decanoate therapy was not associated with hepatotoxicity or an increase in blood pressure. Voice change and mild hirsutism were observed in most of the women receiving nandrolone decanoate, and these secondary effects constitute a real disadvantage to its use in females. In conclusion, our results showed that androgens are a useful alternative in the treatment of anaemia in male haemodialysis patients older than 55 years. Furthermore, the response obtained was similar to that observed with erythropoietin, but at a lower cost.