Effect of pentoxifylline on anemia in patients with chronic kidney disease: an updated systematic review and meta-analysis

Background: Pentoxifylline, a valuable medication with promising clinical characteristics and considerable profile of safety is used in many conditions namely chronic kidney diseases (CKD). However, the decision to prescribe pentoxifylline for anemia in CKD should be based on evidence accrued from randomized controlled trials (RCTs). Yet, substantial heterogeneity exists in studies performed to evaluate pentoxifylline therapy, particularly in relation to classification of patients, the different quality and research design, sample size, baseline parameters, clinical outcome measures, and definition of endpoints and clinically meaningful improvements. As a result, assessment of pentoxifylline in treating anemia of CKD by conducting a systematic review and meta-analysis of the published relevant clinical studies seems rational and promising. Methods: The present systematic review was done in accordance with the PRISMA guideline for systematic reviews and meta-analysis. Peer-reviewed RCTs with at least four weeks of follow-up were including in the meta-analysis. Online databases (PubMed/Medline, ISI Web of Science, Embase, and Scopus) were searched to December 2017 using selected MeSH terms related to the studied topic. Data was extracted independently by two reviewers using a standard form and then cross-checked. Statistical analyses were carrying out with Stata Software, version 7.0 (Stata Corp., College Station, TX, USA). P value of less than 0.05 was considered statistically significant. Data are presented as standard mean difference (SMD) and confidence interval (CI) 95%. Results: According to the predefined criteria, a total of ten studies (parallel group or cross-over trials, and case-control studies) were included and screened for data extraction by two reviewers, separately. The preliminary results extracted from meta-analysis have shown that pentoxifylline can significantly increase transferrin saturation (SMD: 0.348; CI95%: 0.008, 0.688), but there were no conclusive effects of pentoxifylline on hemoglobin (SMD: 0.171; CI95%: -0.390, 0.732), hematocrit (SMD: 0.466; CI95%: -1.426, 2.357), ferritin (SMD: -0.010; CI95%: -0.346, 0.326), and administered dose of erythropoietin (SMD: 0.114; CI95%: -0.232, 0.460), in pooled analyses. Conclusion: There is uncertainty about therapeutic effects of pentoxifylline on anemia of CKD patients. Since these patients has many diverse complications and receive multiple drug therapy, the results of such meta-analysis regarding outcomes of pentoxifylline therapy may have beneficial effects on rational drug prescription.