Administration of pentoxifylline to improve anemia of hemodialysis patients

Abstract

Introduction: One of the most important causes of erythropoietin-resistant anemia in end-stage renal disease (ESRD) patients is increased levels of inflammatory cytokines. Objectives: In this study pentoxifylline, an anti-inflammatory and anti-cytokine drug, with no significant side effects was used to manage anemia in ESRD patients. Patients and Methods: Thirty-nine ESRD patients with erythropoietin-resistant anemia were assigned to two groups, the treatment and the control groups. In treatment group, 19 patients received erythropoietin, venofer and pentoxifylline for 6 months. Patients in control group received erythropoietin and venofer. Hemoglobin (Hb), hematocrit (Hct), albumin and quantitative C-reactive protein (CRP) were measured at the beginning of the study, monthly and at the end of the study. Results: Hb and Hct were significantly increased in the treatment group (9.33±1.25 g/dL and 28.08±3.88% at baseline; 11.22 ± 1.26 g/dL and 34.02 ± 3.72% at sixth month, P = 0.01), but not in the control group. CRP was significantly decreased in the treatment group but no significant change occurred in the control group. Conclusion: Pentoxifylline is effective in improvement of erythropoietin-resistant anemia in ESRD patients.

Effect of Pentoxifylline Administration on Hemoglobin Level of Hemodialysis Patients

“…That was in agreement with Gonzalez-Espinoza and colleagues [21] that showed a significant reduction in all inflammatory markers named CRP, IL-6, and TNF-alfa in the treatment group by the end of the study. In our study, serum albumin increased significantly in the treatment group in agreement with the study conducted by Shahbazani et al, [8] in 2017. On the other hand, the study conducted by Antunes and colleagues (2014) [26] showed no significant changes in serum albumin or CRP between both groups at the end of the study.…”

“…However, they selected patients with Hb <10.7 despite receiving an ESA dose equal to or more than 12000IU /week. On the other hand, Shahbazian et al, [8] reported a higher percent than ours. They found that 53% of their HD patients had anemia despite sufficient iron stores and appropriate ESA dose after exclusion of known causes of ESA hyporesponsiveness.…”

“…However, their patients used a higher dose of pentoxifylline (double the dose) than that used in our trial. In 2017, Shahbazian H and colleagues [8] studied the administration of pentoxifylline in 19 ESRD patients with erythropoietin-resistant anemia versus a control group of the same characteristics for 6 months. By the end of the study, hemoglobin and hematocrit were significantly higher in the treatment than the control group.…”

“…Chronic inflammation frequently hinders the patient response to ESA necessitating to increase its dose. Administration of pentoxifylline as an anti-inflammatory drug in ESRD patients on ESA therapy has been studied in a few numbers of clinical trials [8,9] .…”

The relationship between anemia and Kt/V index in patients undergoing continuous ambulatory peritoneal dialysis and hemodialysis

“…The presence of anemia in hemodialysis patients can increase the mortality rate in this group of patients (3). It can cause fatigue, asthenia, and dyspnea, however, in some cases, the symptoms of anemia may quickly develop with higher intensity (4). Anemia, a symptom of chronic kidney disease (CKD), is one of the most important indices that can be related to many interfering factors (5).…”