Use of Androgens in Patients with Renal Failure

Abstract

Anabolic steroids have been used for the treatment of the anemia of chronic renal failure for more than 25 years. Due to concerns over adverse effects, their use historically has been limited to nandrolone decanoate given to men, usually over age 50, who have intact kidneys. The introduction of epoetin alfa in 1989 has led to reduced androgen use for the treatment of anemia. Nevertheless, there continues to be scientific investigation into the possible role that androgens may play in combination with or as an alternative to erythropoietin. Whether combination therapy will prove to be useful remains to be determined in a large, prospective, randomized trial. There is little likelihood, based on present literature, that androgen therapy alone will replace epoetin alfa in U.S. dialysis units. This topic was addressed recently by the Anemia Work Group of the National Kidney Foundation Dialysis Outcomes Quality Initiative (27). While acknowledging androgen treatment may be less expensive than epoetin alfa, the group stated that the potential risks of primary androgen therapy alone make this form of treatment "unacceptable." The work group did not offer any recommendations on the combined use of erythropoietin and androgens, stating that published data are inconclusive. If future reimbursement policies are changed to include epoetin alfa within a capitated rate, economic incentives may lead to increased use of androgens to achieve targeted hematocrit values. The potential value of anabolic steroids for treating malnutrition in dialysis patients is an intriguing idea. Very little has been done to explore this issue, and this clinical practice has not become widespread nor universally recommended (28). Prospective clinical trials in this area may be warranted as well.

Nutritional Effect of Nandrolone Decanoate in Predialysis Patients With Chronic Kidney Disease

“…Although several previous studies have demonstrated the beneficial effect of nandrolone decanoate in treating anemia in CKD, [15][16][17][18][19] the Hct levels in the present study were not significantly increased after 3-month nandrolone decanoate treatment ( Table 2). This might be explained by the already high Hct levels before the study in the participating patients ( Table 1).…”

“…In general, salt and water retention should be monitored in the use of nandrolone decanoate, especially in patients with initial low daily urine output, uncontrolled hypertension, and history of congestive heart failure. 15,20 One might argue that the increased LBM, increased furosemide dose, and decreased serum albumin levels in the NAN group would suggest that nandrolone decanoate caused fluid retention leading to the occurrences of all the above findings. Indeed, the NAN group had a higher serum creatinine change than the control group ( Table 2), indicating that the increase in LBM was actually related to accrual of muscle rather than fluid.…”

“…2,14 Androgen, an anabolic steroid, has been initially used in the treatment of anemia in patients with CKD. [15][16][17][18][19] Recently, the nutritional benefit of androgen has been shown in patients treated with hemodialysis and continuous ambulatory peritoneal dialysis. 20 -26 In predialysis patients with CKD, there are still insufficient data regarding the effect of androgen on nutritional status.…”

An update on nutrition in chronic kidney disease

“…Likewise, the anabolic properties of androgens in kidney failure patients have been rediscovered recently [32][33][34][35][36][37][38]. In a randomized study, Johansen et al administered 100 mg of nandrolone decanoate for six months and measured body composition by DEXA and physical capacity by a treadmill test [36].…”

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“…Because of the relatively high cost of recombinant human erythropoietin, the use of Nandrolone Decanoate (ND) a non-17alpha-alkylated androgen has been suggested instead of the above mentioned hormone [2,6]. Many studies have shown that ND not only increased RBC production, but also prolonged RBC survival [7]. In spite that the drug is associated with high incidence of adverse effects including acne, virilization, abnormal liver function, discomfort from intramuscular injection [7], It can increase weight, triceps skinfold thickness, nitrogen balance and bone mineral density [2,7].…”