Effect of Pentoxifylline on the Dose of Erythropoietin among Hemodialysis Patients: A Double-Blind Randomized Clinical Trial

Introduction: It was suggested that pentoxifylline (PTX) might improve the response to recombinant human erythropoietin (rhEPO) in anemic hemodialysis (HD) patients. However, there is no considerable evidence for it. We aimed to evaluate the effect of PTX on anemia and prescription of rhEPO dose in HD patients. Methods: This double-blind randomized clinical trial study was conducted on 57 HD patients (54.1 ± 13.8 years old and 52.6% of them were women). Patients were randomly categorized into 2 groups (27 PTX cases and control group with 30 cases). Hemoglobin (Hb), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and albumin (Alb) were measured before and after the study. Data were analyzed using SPSS, and p-value <0.05 was considered significant. Results: Hb levels increased significantly after treatment in both groups (p<0.002). Although the mean Hb change in the PTX group was more but not significant (p=0.195). rhEPO dose decreased significantly after treatment in the PTX groups (11000.0 ± 3140.0 IU vs. 9100.0 ± 3400.0 IU, p=0.018) compared to the control (11130.0 ± 3180.0 IU vs. 10870.0 ± 3900.0 IU, p= 0.690). CRP levels significantly reduced only in the PTX group (22.8 ± 15.3 vs. 16.5 ± 9.5, p=0.005). Also, a significant increase in Alb was observed only in the PTX (3.9 ± 0.4 vs. 4.1 ± 0.3, p=0.031). Conclusion: Using the PTX may reduce the required rhEPO dose, so it could be used in the anemia treatment in HD patients. Although, as a therapeutic strategy in HD patients with anemia it is controversial. Due to the limitations of the studies in this field, further studies with more sample size are recommended.