title: Pentoxifylline for Anemia in Chronic Kidney Disease: A Systematic Review and Meta-Analysis.
abstract: BACKGROUND
  Pentoxifylline (PTX) is a promising therapeutic approach for reducing inflammation and improving anemia associated to various systemic disorders. However, whether this agent may be helpful for anemia management also in CKD patients is still object of debate.
  
  
  METHODS
  Systematic review and meta-analysis.
  
  
  METHODS
  Adults with CKD (any KDOQI stage, including ESKD patients on regular dialysis) and anemia (Hb<13 g/dL in men or < 12 g/dL in women).
  Cochrane CENTRAL, EMBASE, Ovid-MEDLINE and PubMed were searched for studies providing data on the effects of PTX on anemia parameters in CKD patients without design or follow-up restriction.
  
  
  METHODS
  PTX derivatives at any dose regimen.
  
  
  RESULTS
  Hemoglobin, hematocrit, ESAs dosage and resistance (ERI), iron indexes (ferritin, serum iron, TIBC, transferrin and serum hepcidin) and adverse events.
  
  
  RESULTS
  We retrieved 11 studies (377 patients) including seven randomized controlled trials (all comparing PTX to placebo or standard therapy) one retrospective case-control study and three prospective uncontrolled studies. Overall, PTX increased hemoglobin in three uncontrolled studies but such improvement was not confirmed in a meta-analysis of seven studies (299 patients) (MD 0.12 g/dL, 95% CI -0.22 to 0.47). Similarly, there were no conclusive effects of PTX on hematocrit, ESAs dose, ferritin and TSAT in pooled analyses. Data on serum iron, ERI, TIBC and hepcidin were based on single studies. No evidence of increased rate of adverse events was also noticed.
  
  
  CONCLUSIONS
  Small sample size and limited number of studies. High heterogeneity among studies with respect to CKD and anemia severity, duration of intervention and responsiveness/current therapy with iron or ESAs.
  
  
  CONCLUSIONS
  There is currently no conclusive evidence supporting the utility of pentoxifylline for improving anemia control in CKD patients. Future trials designed on hard, patient-centered outcomes with larger sample size and longer follow-up are advocated.
authors.affiliation: CNR- Institute of Clinical Physiology, Reggio Calabria, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Bolignano
authors.affiliation: CNR- Institute of Clinical Physiology, Reggio Calabria, Italy.
authors.forename: Graziella
authors.initials: G
authors.lastname: D'Arrigo
authors.affiliation: CNR- Institute of Clinical Physiology, Reggio Calabria, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Pisano
authors.affiliation: Nephrology and Dialysis Unit, University Hospital, Catanzaro, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Coppolino
mesh_terms: D000328:Adult; D000740:Anemia / Q000150:complications* / Q000188:drug therapy*; D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D010431:Pentoxifylline / Q000009:adverse effects / Q000627:therapeutic use*; D010726:Phosphodiesterase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D010726:Phosphodiesterase Inhibitors; D010431:Pentoxifylline