Nutritional management of the continuous ambulatory peritoneal dialysis patient

Effect of Androgens on Anemia and Malnutrition in Renal Failure: Implications for Patients on Peritoneal Dialysis

Objective

To analyze the implications of the potential use of androgens in peritoneal dialysis patients, focusing on their effects on hematologic and nutritional parameters. This manuscript reviews the different compounds for clinical use, dosage schedules, adverse effects, and how therapy with androgens might be used to treat anemia and malnutrition in these dialysis patients.

Data Sources

Studies in the literature dealing with the effects of androgens on hematologic and nutritional parameters, and their role in uremic anemia and malnutrition.

Study Selection

Studies in which uremic patients received androgens as therapy for anemia or malnutrition.

Data Extraction

Data were abstracted from all of these studies.

Results

This review shows that androgens are anabolic substances that also have significant actions on erythropoiesis. A number of clinical studies in uremic patients have found that these compounds have beneficial effects on hematologic parameters and nutritional status, similarly to other therapies, such as recombinant human erythropoietin and recombinant human growth hormone, respectively.

Conclusions

Androgens have been shown to have a beneficial effect on anemia due to renal disease and on nutritional status in uremic patients. Further studies need to be done with larger groups of patients. Objectives for additional research are suggested.

Nutritional problems associated with end-stage renal disease in the developing world

Protein-energy malnutrition is a major problem in dialysis patients. There is increased morbidity and mortality in dialysis patients with malnutrition. There are very few published studies on nutritional parameters and adequacy of dialysis from the developing world and especially from Africa. There was a significant improvement in neuromuscular function and nutrition in 22 hemodialysis patients in Egypt with optimization of dialysis dose and nutritional status. In a study of 82 continuous ambulatory peritoneal dialysis (CAPD) patients in Durban, South Africa, there was a reduction in the number of hospital admissions in adequately dialyzed patients (achieving Kt/V of >2.1). In another study of 84 CAPD patients from the same center, 76.2% of patients were assessed as being malnourished, with loss of appetite being an important etiological factor. Strategies to optimize dialysis dose, together with services of a renal dietician, will assist in improving the nutrition of patients with chronic renal failure.