Meta-Analysis of Randomized Controlled Trials on Androgens versus Erythropoietin for Anaemia of Chronic Kidney Disease: Implications for Developing Countries

Androgens which are relatively cheap were used in the treatment of anaemia in dialysis patients before the advent of Erythropoietin (EPO). However, there are concerns about their efficacy and side effects. Aims. To examine the efficacy and harms of androgens for the treatment of anaemia of chronic kidney disease (CKD) compared to EPO. Settings and Design. A systematic review and meta-analysis using an a priori protocol. Methods and Materials. We searched several databases for randomized controlled trials using the key terms anaemia, chronic kidney disease, and androgens, without language restrictions. We also searched reference lists of relevant articles. Statistical Analysis Used. Data was analyzed using Review manger 5 software. We summarized treatment effects as relative risks and mean differences, with 95% confidence intervals using a random-effect model. We tested for heterogeneity with Chi(2) and the I(2) statistics. Results. We identified four eligible trials involving 114 participants, majority (83.33%) of whom were males, mostly over 50 years of age. The pooled difference in mean haemoglobin between the nandrolone and EPO arms at the end of the trials was -0.11 (CI -0.80 to 0.58) which is not statistically significant. Conclusions. This meta-analysis revealed no difference between nandrolone and EPO for the treatment of anaemia of CKD in men over 50 years. Therefore, nandrolone can be used for the treatment of anaemia of CKD in this category of patients, in resource-limited countries. However, further studies are needed to determine the long-term safety of nandrolone in men over 50 years old, as well as its effectiveness and safety in females in general, and males less than 50 years of age.