Administration of pentoxifylline to improve anemia of hemodialysis patients

Heshmatolah Shahbazian, Ali Ghorbani, Azita Zafar-Mohtashami, Abdolreza Balali, Armaghan AleAli, Gholam Reza Lashkarara, Heshmatolah Shahbazian, Ali Ghorbani, Azita Zafar-Mohtashami, Abdolreza Balali, Armaghan AleAli, Gholam Reza Lashkarara

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.

Keywords: Anemia; Cytokine; End-stage renal disease; Pentoxifylline.

References

    1. Brenner M, Jacob G. Chronic renal failure. In: Kasper D, Braunwald E, Fauci S, eds. Harrison’s Principles of Internal Medicine. 17th ed. New York: McGraw-Hill; 2008:2208.
    1. Nissenson AR, Pereira BT, Collins AJ. Prevalence and characteristics of individuals with chronic kidney disease in a large health maintenance organization. Am J Kidney Dis. 2001;37:1177–1183. doi: 10.1053/ajkd.2001.24520.
    1. Haghighi AN, Broumand B, D’Amico M, Locatelli F, Ritz E. The epidemiology of end-stage renal disease in Iran in an international perspective. Nephrol Dial Transplant. 2002;17:28–32.
    1. Coresh J, Astor B C, Greene T, Eknoyan G, Levey A. Prevalence of chronic kidney disease and decreased kidney function in the adult US population: Third National Health and Nutrition Survey. Am J Kidney Dis. 2003;41:1–12.
    1. Kazmi WH, Kausz AT, Khan S, Abichandani R, Ruthazer R, Obrador GT. et al. Anemia: an early complication of chronic renal insufficiency. Am J Kidney Dis. 2001;38:803–12.
    1. Ma JZ, Ebben J, Xia H, Collins AJ. Hematocrit level and associated mortality in hemodialysis patients. J Am Soc Nephrol. 1999;10:610–9.
    1. 2005 annual report. ESRD Clinical performace measures project. AM J Kidney Dis. 2006;48:533.
    1. Levin A, Thrompson CR, Ethier J, Carisie EJ, Tobe S, Mendelssohn D. et al. Left ventricular mass index increase in early renal disease: impact of decline in hemoglobin. Am J Kidney Dis. 1999;34:125–34. doi: 10.1016/S0272-6386(99)70118-6.
    1. Collins AJ, Ma JZ, Ebben J. Impact of hematocrit on morbidity and mortality. Semin Nephrol. 2000;20:345–9.
    1. Benbernou N, Esnault S, Potron G, Guenounou M. Regulatory effects of pentoxifylline on T-helper cell-derived cytokine production in human blood cells. J Cardiovasc Pharmacol. 1995;25:S75–9.
    1. Wenisch C, Looareesuwan S, Wilairatana P, Parschalk B, Vannapann S, Wanaratana V. et al. Effect of pentoxifylline on cytokine patterns in the therapy of complicated Plasmodium falciparum malaria. Am J Trop Med Hyg. 1998;58:343–7.
    1. Frampton JE, Brogden RN. Pentoxifylline (oxpentifylline) A review of its therapeutic efficacy in the management of peripheral vascular and cerebrovascular disorders. Drugs Aging. 1995;7:480–503.
    1. Cooper AC, Mikhail A, Lethbridge MW, Kemeny DM, Macdougall IC. Increased expression of erythropoiesis inhibiting cytokines (IFN-gamma, TNF-alpha, IL-10, and IL-13) by T cells in patients exhibiting a poor response to erythropoietin therapy. J Am Soc Nephrol. 2003;14:1776–84.
    1. Navarro JF, Mora C, Garcia J, Rivero A, Macia M, Gallego E. et al. Effects of pentoxifylline on the hematologic status in anemic patients with advanced renal failure. J Urol Nephrol. 1999;33:121–5.
    1. Yeun JY, Levine RA, Mantadilok V, Kaysen GA. C-reactive protein predicts all-cause and cardiovascular mortality in hemodialysis patients. Am J Kidney Dis. 2000;35(3):469–76.
    1. Kalantar-Zadeh K. Recent advances in understanding the malnutrition–inflammation–cachexia syndrome in chronic kidney disease patients: What is next? Semin Dial. 2005;18:365–369.
    1. Streetz KL, Wustefeld T, Klein C, Manns MP, Trautwein C. Mediators of inflammation and acute phase response in the liver Cell Mol Biol. (Noisy-le-Grand) 2001;47:661–73.
    1. Suffredini AF, Fantuzzi G, Badolato R, Oppenheim JJ, Grady NP. New insights into the biology of the acute phase response. J Clin Immunol. 1999;19:203–214.
    1. Cooper A, Mikhail A, Lethbridge MW, Kemeny DM, Macdougall IC. Pentoxifylline improves hemoglobin levels in patients with erythropoietin-resistant anemia in renal failure. J Am Soc Nephrol. 2004;15:1877–82.
    1. Johnson DW, Hawley CM, Rosser B, Beller E, Thompson C, Fassett RG. et al. Oxpentifylline versus placebo in the treatment of erythropoietin-resistant anaemia: a randomized controlled trial. BMC Nephrol. 2008;9:8. doi: 10.1186/1471-2369-9-8.

Source: PubMed

3
Abonnieren