title: Androgens for the anaemia of chronic kidney disease in adults.
abstract: BACKGROUND
  Anaemia occurs when blood contains fewer red blood cells and lower haemoglobin levels than normal, and is a common complication among adults with chronic kidney disease (CKD). Although a number of approaches are applied to correct anaemia in adults with CKD, the use of androgen therapy is controversial.
  
  
  OBJECTIVE
  The aim of this review was to determine the benefits and harms of androgens for the treatment of anaemia in adult patients with CKD.
  
  
  METHODS
  We searched CENTRAL, the Cochrane Renal Group's Specialised Register, the Chinese Biomedicine Database (CBM), CNKI, VIP and reference lists of articles without language restriction. The most recent search was conducted in August 2014.
  
  
  METHODS
  All randomised controlled trials (RCTs) that assessed the use of androgens for treating anaemia of CKD in adults were eligible for inclusion.
  
  
  METHODS
  Two authors independently extracted data and assessed risk of bias in the included studies. Meta-analyses were performed using relative risk (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, with 95% confidence intervals (CI).
  
  
  RESULTS
  We included eight studies that reported data from 181 participants. Study quality was assessed as moderate in six studies, one was low quality, and one was high quality. The small number of included studies, and low participant numbers adversely influenced evidence quality overall.We found limited evidence (1 study, 24 participants) to indicate that oxymetholone can increase haemoglobin (Hb) (MD 1.90 g/dL, 95% CI 1.66 to 2.14), haematocrit (HCT) (MD 27.10%, 95% CI 26.49 to 27.71), change in albumin (MD 4.91 g/L, 95% CI 3.69 to 6.13), alanine aminotransferase (ALT) (MD 54.50 U/L, 95% CI 43.94 to 65.06), and aspartate aminotransferase (AST) (MD 47.33 U/L, 95% CI 37.69 to 56.97); and decrease high-density lipoprotein (HDL) (MD -15.66 mg/dL, 95% CI -24.84 to -6.48). We also found that compared with erythropoietin alone, nandrolone decanoate plus erythropoietin may increase HCT (3 studies, 73 participants: MD 2.54%, 95% Cl 0.96 to 4.12). Compared with erythropoietin (1 study, 27 participants), limited evidence was found to suggest that nandrolone decanoate can increase plasma total protein (MD 0.40 g/L, 95% CI 0.13 to 0.67), albumin (MD 0.20 g/L, 95% CI 0.01 to 0.39), and transferrin (MD 45.00 mg/dL, 95% CI 12.61 to 77.39) levels. Compared with no therapy (remnant kidney), evidence was found to suggest that nandrolone decanoate can increase Hb (2 studies, 33 participants: MD 1.04 g/dL, 95% Cl 0.66 to 1.41) and HCT (1 study, 24 participants: MD 3.70%, 95% Cl 0.68 to 6.72). Compared with no therapy (anephric), evidence was found (1 study, 5 participants) to suggest that nandrolone decanoate can increase Hb (MD 1.30 g/dL, 95% Cl 0.57 to 2.03), but nandrolone decanoate did not increase HCT (MD 2.00%, 95% Cl -0.85 to 4.85).However, oxymetholone was not found to reduce blood urea nitrogen (BUN), serum creatinine (SCr), cholesterol, or triglycerides; or increase plasma total protein, prealbumin, or transferrin. No evidence was found to indicate that nandrolone decanoate increased prealbumin or decreased BUN, SCr, AST, ALT, cholesterol, triglycerides, HDL or low-density lipoprotein (LDL). Adverse events associated with androgen therapy were reported infrequently.
  
  
  CONCLUSIONS
  We found insufficient evidence to confirm that use of androgens for adults with CKD-related anaemia is beneficial.
authors.affiliation: Graduate School of Pharmaceutical Sciences, College of Pharmacy, Ewha Woman's University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul, Korea, South, 120-750.
authors.forename: Qianchun
authors.initials: Q
authors.lastname: Yang
authors.forename: Minawaer
authors.initials: M
authors.lastname: Abudou
authors.forename: Xi Sheng
authors.initials: XS
authors.lastname: Xie
authors.forename: Taixiang
authors.initials: T
authors.lastname: Wu
mesh_terms: D000328:Adult; D000728:Androgens / Q000627:therapeutic use*; D000740:Anemia / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D002784:Cholesterol / Q000097:blood; D004921:Erythropoietin / Q000627:therapeutic use; D006400:Hematocrit; D006801:Humans; D009277:Nandrolone / Q000031:analogs & derivatives / Q000627:therapeutic use; D000077603:Nandrolone Decanoate; D010110:Oxymetholone / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D014280:Triglycerides / Q000097:blood
chemical_list: D000728:Androgens; D014280:Triglycerides; D004921:Erythropoietin; D009277:Nandrolone; D002784:Cholesterol; D000077603:Nandrolone Decanoate; D010110:Oxymetholone