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.
Highlights
One of the most important causes of erythropoietin-resistant anemia in endstage renal disease (ESRD) patients is increased levels of inflammatory cytokines
According to the World Health Organization (WHO) with the increasing incidence and prevalence of diabetes and the relationship between diabetes and kidney disease, in the near future we will encounter a significant increase in kidney disease [2]
According to WHO criteria, 90% of Chronic kidney disease (CKD) patients with glomerular filtration rate (GFR)
Summary
One of the most important causes of erythropoietin-resistant anemia in endstage 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. Conclusion: Pentoxifylline is effective in improvement of erythropoietin-resistant anemia in ESRD patients. Alpha epoetin (EPO) and some other similar drugs have become the standard treatment for anemia in CKD patients [5] Resistance to these drugs is increasing due to chronic inflammation in these patients. Pentoxifylline is commonly used for peripheral vascular diseases but it may have anti-inflammatory effects [10] It prevents the production of tumor necrosis factoralpha (TNF-α) in lymphocytes and reducing TNF-α and C-reactive protein (CRP) in circulatory system. Anaphylactoid reactions, angioedema, angina pectoris, and other side effects have been rarely reported [12]
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