Korean Journal of Nephrology 2001;20(1):67-74.

원저 : 혈액투석 환자에서 Erythropoietin 의 피하주사와 저용량 Androgen 의 병용투여가 빈혈과 영양지표에 미치는 효과 (Effects of Low-dose Androgen in Combination with Subcutaneous Recombinant Human Erythropoietin (r-HuEPO) on Anemia and Nutritional Parameters in Hemodialysis Patients)

서정철(Jeong Chul Seo),김혜영(Hye Young Kim),양용모(Yong Mo Yang),전원중(Won Joong Jeon),이현희(Hyun Hee Lee),이경수(Kyoung Soo Lee),정지봉(Ji Bong Jeong),엄재호(Jae Ho Earm),이기형(Ki Hyeong Lee)

Abstract

Recombinant human erythropoietin(r-HuEPO) is the mainstay of anemia therapy in patient with end stage renal disease(ESRD), but the use of r-HuEPO is primarily limited by its high cost. So, it encourages any strategies that potentially enhance the erythropoietic response. However, studies designed to assess whether androgens would enhance the response to r-HuEPO were inconclusive. While androgens may be less expensive and may improve several nutritional parameters, their potential adverse effects discourage usage. We carried out a prospective study to examine the effect of low-dose androgen in combination with subcutaneous r-HuEPO on anemia and nutritional paramenters in hemodialysis patients. Twenty-four hemodialysis patients with hematocrit <24% or hemoglobin <8.0g/dL were randomly assigned into two groups. Group A(n=12) received 2000U r-HuEPO subcutaneously twice a week for six months. Group B(n=12) received the same dose of r-HuEPO plus nandrolone decanoate 100mg intramuscularly biweekly. Anthropometry, albumin, cholesterol, prealbumin, and transferrin were measured as nutritional parameters. The groups showed no differences in baseline levels of the followings : Hemoglobin, hematocrit; transferrin saturation, serum ferritin; intact serum parathyroid hormon, Kt/V; vitamin Biz, folate; nutritional parameters. At the cornpletion of the study, both groups showed significant increase in hematocrit compared with baseline levels(group A 20.7±2.2M to 26.0±3.8%; group B: 21.5±3.5% to 30.1±2.8%). The mean hematocrit in group B was significantly higher than in group A after 4 month study period(p<0.05). Ten of 12 patients in group B achieved a target hematocrit of 30%, as compared with four of 12 patients in group A. Both groups didn't show significant changes in any nutritional parameters. No significant side effects of androgen were noted during this short-term study. We conclude that low-dose androgen in combination with subcutaneous r-HuEPO is effetive treatment on anemia in hemodialysis patients, but does not improve nutritional status.