Meta-Analysis of Randomized Controlled Trials on Androgens versus Erythropoietin for Anaemia of Chronic Kidney Disease: Implications for Developing Countries

Abstract

Androgens which are relatively cheap were used in the treatment of anaemia in dialysis patients before the advent of Erythropoietin (EPO). However, there are concerns about their efficacy and side effects. Aims. To examine the efficacy and harms of androgens for the treatment of anaemia of chronic kidney disease (CKD) compared to EPO. Settings and Design. A systematic review and meta-analysis using an a priori protocol. Methods and Materials. We searched several databases for randomized controlled trials using the key terms anaemia, chronic kidney disease, and androgens, without language restrictions. We also searched reference lists of relevant articles. Statistical Analysis Used. Data was analyzed using Review manger 5 software. We summarized treatment effects as relative risks and mean differences, with 95% confidence intervals using a random-effect model. We tested for heterogeneity with Chi2 and the I2 statistics. Results. We identified four eligible trials involving 114 participants, majority (83.33%) of whom were males, mostly over 50 years of age. The pooled difference in mean haemoglobin between the nandrolone and EPO arms at the end of the trials was −0.11 (CI −0.80 to 0.58) which is not statistically significant. Conclusions. This meta-analysis revealed no difference between nandrolone and EPO for the treatment of anaemia of CKD in men over 50 years. Therefore, nandrolone can be used for the treatment of anaemia of CKD in this category of patients, in resource-limited countries. However, further studies are needed to determine the long-term safety of nandrolone in men over 50 years old, as well as its effectiveness and safety in females in general, and males less than 50 years of age.

Association between Testosterone and Mortality Risk among U.S. Males Receiving Dialysis

“…Indeed, a recent meta-analysis comparing nandrolone vs. erythropoietin in the treatment of anemia of renal disease showed no significant difference in hemoglobin level across the two groups. [29] These collective data warrant future studies that will examine whether correction of testosterone deficiency ameliorates hard outcomes such as cardiovascular disease and death in dialysis patients, as well as the optimal total testosterone target range in this population.…”

A systematic review and meta-analysis of effect of synthetic erythropoietin on hemoglobin in dialysis patients

“…At the end of the experiment, the difference between the mean Hb due to the administration of nandrolone and erythropoietin was -0.11 (95% CI: 0.80-0.58), which was not statistically significant. The aforementioned meta-analysis demonstrated no difference between nandrolone and erythropoietin in the treatment of CKD anemia (30).…”

Nandrolone decanoate relieves joint pain in hypogonadal men: a novel prospective pilot study and review of the literature

“…While quite capable in this regard with fewer androgenic side effects compared to testosterone (the previous standard of care), nandrolone's use in the treatment of anemia was largely supplanted in the late 1980s with the introduction of recombinant human erythropoietin (EPO) (21). Interestingly, nandrolone is still occasionally used as an alternative for select patients who cannot tolerate EPO and for patients in resource-limited countries (21)(22)(23). Outside of its historical indication for anemia, nandrolone has also shown promise in the treatment of osteoporosis and the sarcopenic states commonly observed in advanced chronic obstructive pulmonary disease (COPD), acquired immunodeficiency syndrome (AIDS), and end-stage renal disease (ESRD) (24)(25)(26)(27).…”