Clinical effects of oral fluoxymesterone in patients with dialysis-controlled uremia

Influence of continuous ambulatory peritoneal dialysis on the anemia of endstage renal disease

To evaluate the effect of continuous ambulatory peritoneal dialysis (CAPD) on the anemia of endstage renal disease, serial measurements of red cell mass and other hematological parameters were performed in 34 patients. Twenty-five patients were measured at the start and at 6 months (group 1), 13 at the start, at 6 and 12 months (group 2), and 11 were followed during their second year of treatment with measurements at 12, 18, and 24 months (group 3). In group 1 the hematocrit rose from 24.6 +/- 0.9 to 29.9 +/- 0.8% (P less than 0.01). The red cell mass increased from 879 +/- 44 to 1019 +/- 47 ml (P less than 0.01). The calculated plasma volume decreased from 2915 +/- 174 to 2568 +/- 136 ml (P less than 0.01). In group 2 at 6 months the hematocrit rose from 24.7 +/- 1.2 to 30.7 +/- 1.0% (P less than 0.01); the red cell mass increased from 924 +/- 66 to 1059 +/- 71 ml (P less than 0.05). The calculated plasma volume decreased at 6 months from 3001 +/- 201 to 2555 +/- 170 ml (P less than 0.01). No significant changes occurred between 6 and 12 months. In group 3 no significant changes in hematocrit, red cell mass, or plasma volume were observed. It is concluded that the rise in hematocrit in CAPD patients is due to an increase in red cell mass and also to a decrease in plasma volume. These changes are manifest within 6 months of treatment. The rise in red cell mass represents an improvement in renal anemia in these patients.

[Erythropoietin in serum and urine in healthy persons and patients with chronic renal disease upon hypoxic stimulation and hypoxic stimulation after pretreatment with fluoxymesterone (author's transl)]

The question of a latent erythropoietin (ESF)-deficiency was studied in incipient renal anemia using a double stimulation technique for ESF. After a 4-week stimulation of ESF production with oral administration of fluoxymesterone (flu) intermittent hypoxic ESF stimulation was performed corresponding to a maximum altitude of 4000 m in 7 patients with chronic renal disease without or with incipient renal anemia (mean hematocrit 40%) and in 11 normal subjects (mean hematocrit 46%). Double stimulation in patients was compared with hypoxic stimulation alone and both were compared with controls. After flu alone only ESF excretion was increased in patients and in normal subjects. After flu plus 10 h of hypoxia serum ESF--titers were higher in healthy subjects than in the patients. The mean ESF titer after double stimulation was 81 mU/ml in patients and 115 mU/ml in normal persons. Forty-eight hour ESF excretion was 11 U and 43 U respectively. Compared to hypoxic stimulation alone double stimulation increased serum ESF titers in patients by 5% versus 80% in controls. Correspondingly, ESF excretion was enhanced by 19% and 49%, respectively. Finally, renal ESF clearance was increased by 42% versus 200%. After hypoxia alone non-anemic patients had higher serum ESF titers than healthy controls excluding a latent ESF deficiency in incipient renal anemia. It is concluded that decreased ESF production after double stimulation in patients was due to a nephrotoxic effect of flu followed by a decreased excretory and ESF-producing function of the damaged kidneys.

A controlled trial of nondrolone decanoate in the treatment of uremic anemia

Thirty-seven male dialysis patients, from three university hospital centers known to have adequate iron B12, and folate stores, were entered into a controlled trial to study the effects of nandrolone decanoate (200 mg i.m. weekly) on their anemia. An initial six-month stabilization period was followed by a randomized 12-month study, with crossover between treatment and control groups occurring at six months. Patients received parenteral iron therapy plus oral folate throughout the trial. All serious illnesses or major blood losses excluded the patients from analysis. The 24 patients with remnant kidneys showed an increase in hemoglobin and hematocrit of 24% by the end of six months of treatment (P less than 0.005), with a corresponding decrement during the six months of control, but the five anephric patients showed no statistically significant change compared to those patients whose kidneys were in place during the study. Complications of treatment were minimal, with injection site hematoma the only significant local effect and a rise in triglyceride the only significant systemic disturbance. Despite the improvement in anemia, the disadvantages, including the high cost of treatment, the apparent plateauing of benefits by five months, the minimal subjective improvement in life style, the risk of i.m. injection, plus the long term effects of increased lipids, should limit this therapy to patients with remnant kidneys who have severe symptomatic anemia or frequent transfusion requirements.

Fluoxymesterone therapy in anemia of patients on maintenance hemodialysis: comparison between patients with kidneys and anephric patients

Nineteen patients with their kidneys and 11 anephric patients who were stable on maintenance hemodialysis received 20 mg a day of Fluoxymesterone. At the end of four months, there was a significant increase (p less than 0.005) in the mean hematocrit with a parallel increase in the hemoglobin level in both groups of patients. Concomitantly, we observed an increment of the red cell mass that was significant at the level of p less than 0.05. Blood transfusion requirements decreased significantly (p less than 0.1), independent of the presence or absence of kidneys. No changes in body weight, serum albumin, and serum cholesterol levels were observed. Secondary effects were hirsutism and hoarsening of the voice.