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Another Use of Androgens: Treatment of Anemia of End-Stage Renal Disease^a

Department of Nephrology, Hospital Ntra. Sra. de Candelaria 38010 S/C de Tenerife, Spain

I have read with great interest the excellent review by Bhasin and Bremner (1) about androgen replacement therapy and their anabolic applications in wasting states. I would like to point another aspect of special interest in the androgen field: the use of these substances for the treatment of anemia in patients with end-stage renal disease.

Anemia is a universal complication of renal insufficiency. Although its etiology is multifactorial, the main cause of anemia of renal disease is the deficient production of erythropoietin (EPO) by the kidneys. Since the last years of the 1980s, recombinant human EPO (rHuEPO) has become the standard therapy for renal anemia. However, this treatment has several limitations: the significant side effects, mainly hypertension, and the high cost.

Androgens have been used as treatment for the anemia of end-stage renal disease since 1970 (2, 3); but with the easy availability of rHuEPO, the protocol treatments have completely changed, and androgens have been relegated to background. However, recent studies (4, 5, 6) have reported that androgens produced a significant improvement in anemia of hemodialysis patients, similar to that observed with the use of rHuEPO, with minimal secondary complications and with a lower economical cost. On the other hand, androgens have also demonstrated appreciable anabolic effects in these patients, with a significant increase of body weight and serum albumin concentration (6).

Received March 12, 1997.

References

1. Bhasin S, Bremner WJ. 1997 Emerging issues in androgen replacement therapy. J Clin Endocrinol Metab. 82:3–8.[Free Full Text]
2. DeGowin RL, Lavender AR, Forland M, Charleston D, Gottschalk A. 1970 Erythropoiesis and erythropoietin in patients with chronic renal failure treated with hemodialysis and testosterone. Ann Intern Med. 72:913–918.
3. Richardson Jr JR, Winstein MB. 1970 Erythropoietic response of dialyzed patients to testosterone administration. Ann Intern Med. 73:403–407.
4. Teruel JL, Marcén R, Navarro JF. 1995 Evolution of serum erythropoietin after androgen administration to hemodialysis patients: a prospective study. Nephron. 70:282–286.[Medline]
5. Teruel JL, Aguilera A, Marcén R, Navarro J, García G, Ortuño J. 1996 Androgen therapy for anaemia of chronic renal failure. Scan J Urol Nephrol. 30:403–408.[Medline]
6. Teruel JL, Marcén R, Navarro-Antolín J, Aguilera A, Fernández-Juárez G, Ortuño J. 1996 Androgen versus erythropoietin for the treatment of anemia in hemodialyzed patients: a prospective study. J Am Soc Nephrol. 7:140–144.[Abstract]

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