Improvement of Albumin Control in Hemodialysis Patients—What Is Possible?

Murat H Sipahioglu, Nathan W Levin
US Nephrology, 2008;3(2):54-58
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Pentoxifylline: Pentoxifylline is a non-specific phosphodiesterase inhibitor that inhibits TNF transcription.80 Intravenous administration of pentoxifylline acutely reduced protein catabolism in patients with ESRD.81 The Anti-Inflammatory and Anti-Oxidative Nutrition in Dialysis Patients (AIONID) study will examine the effect of oral nutritional supplements with pentoxiphylline therapy in 100 HD patients.82 This study was started in February 2008, and its estimated completion date is 2010.

Etanercept: Etanercept is a TNF-α blocker. The effectiveness of etanercept on nutritional status and clinical outcomes (albumin and CRP) in HD patients is being studied in a phase II randomized, double-blind, placebocontrolled clinical trial.83

Anakinra: Anakinra is an IL-1 receptor antagonist. There is a single study regarding the pharmacokinetics of this drug in patients with chronic renal failure.84 The HD process was found to have a minimal effect on the removal of anakinra.

Antioxidant therapies: A recent study reported that combined administration of γ-tocopherol and docosahexaenoic acid significantly decreases IL-6 levels in HD patients.85

Tocilizumab: Tocilizumab is a humanized anti-IL-6 receptor monoclonal antibody that binds IL-6 receptors and inhibits IL-6-mediated pro-inflammatory activity. Nishimato et al.86 reported that in patients with rheumatoid arthritis receiving this drug, albumin levels rose by 0.4 and 0.7g/dl with the 4 and 8mg/kg doses, respectively. Toclizumab is also used in patients with Castleman disease, and in one study using tocilizumab at a dose of 8mg/kg, albumin concentration increased from 2.6 to 3.7g/dl in underweight patients.87 There are currently no studies of tocilizumab in patients with chronic renal failure for the treatment of inflammation and hypoalbuminemia, but considering the major role of IL-6 in the negative acute-phase response, tocilizumab has promise for the future. Recent studies that have attempted to raise the serum albumin are summarized in Tables 1 and 2.

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