Effect of pentoxifylline on anaemia control in haemodialysis patients: retrospective observational case-control study

Treatment of anaemia in haemodialysis (HD) with iron and erythropoiesis-stimulating agent (ESA) does not lead to adequate anaemia control and has been associated with inflammation. The anti-inflammatory effect of pentoxifylline (PTX) may be beneficial in these cases. Our aim was to study the potential effect of PTX on anaemia in haemodialysis patients.

Retrospective observational case-control study on 18 patients (treated with PTX) and 18 controls (without PTX matched by age and sex) on HD (Clínica Universidad de Navarra). Four patients received PTX due to vascular disease and 14 due to refractory anaemia (which was defined as haemoglobin [Hb] <11 g/dl in the last three months despite high doses of ESA and transferrin saturation of >20%). Hb, MIRCERA dose and C-reactive protein were recorded before starting PTX treatment (baseline), at 3 months and at the end of the study.

In patients who received PTX, there was an increase in Hb (P<.001) over three months and a decrease in the ESA dose at the end of the study (P=.002). The baseline differences in Hb between groups (lowest of all cases) (P<.001) and ESA dose (highest of all cases) (P=.006), disappeared at 3 months. At the end of the study, 11/18 (61.1%) of patients treated with PTX had adequate Hb levels and received doses of ESA comparable with those of the controls.

In HD patients, PTX in doses of 800 mg/day improves Hb significantly and in the short term (3 months) in HD patients (around 61% response) and allows the required ESA dose to be reduced in the medium-long term. This effect is sustained over time and treatment is tolerated well.