Nandrolone Decanoate Reduces Serum Lipoprotein(a) Concentrations in Hemodialysis Patients Jose L. Teruel, MD, Miguel A. Lasuncion, MD, Maite Rivera, MD, Abelardo Aguilera, MD, Henar Ortega, MD, Ana Tato, MD, Roberto Marcen, MD, and Joaquin Ortufio, MD • We have studied the changes in the lipid profile of 14 chronic hemodialysis patients receiving a 6-month cycle of nandrolone decanoate as treatment for anemia. Nandrolone decanoate was administered in a weekly intramuscular dose of 200 mg and resulted in an increase in the hemoglobin concentration (baseline, 7.9 _+ 0.9 g/dL; month 6, 10.8 _+ 1.7 g/dL; P < 0.001, ANOVA) and also produced relevant modifications in the lipid concentra- tions. The most significant finding was a decrease in the concentration of lipoprotein(a) [Lp(a)]: baseline, 19.8 mg/ dL (median), month 2, 10.6 mg/dL; month 4, 8.7 mg/dL; and month 6, 7.1 mg/dL (P < 0.001, Friedman). Other lipid changes induced by nandrolone decanoate were an increase in the concentrations of apolipoprotein B (P < 0.02, ANOVA) and triglyceride (P = NS, ANOVA) and a decrease of high-density lipoprotein (HDL) cholesterol (P < 0.001, ANOVA) and apolipoprotein A-I (P = NS, ANOVA). The decrease in HDL cholesterol was at the expense of the HDL2 cholesterol subfraction, whereas HDL3 remained unchanged. These lipid modifications were reversible; 4 months after nandrolone decanoate withdrawal, the lipid concentrations were similar to the basal values. The changes in Lp(a) levels did not correlate with those of hemoglobin or the other lipid parameters, suggesting that the underlying mechanisms are unrelated. Our findings could be clinically relevant if confirmed by further studies. © 1997 by the National Kidney Foundation, Inc. INDEX WORDS: Androgens; lipoprotein(a); Iipoproteins; apolipoproteins; hemodialysis. T HE AVAILABILITY of recombinant hu- man erythropoietin has mitigated the use of androgens in the treatment of anemia in dialyzed patients. However, we have observed that the response of anemia to nandrolone decanoate is age dependent and excellent results, similar to those obtained with recombinant human erythro- poietin, can be obtained in elderly male patients at a lower economical cost.1 Moreover, after dis- continuing the use of androgens, the hemoglobin level remains stable in many patients. 2 Therefore, we use intermittent cycles of nandrolone dec- anoate in dialyzed males older than 50 years, and recombinant human erythropoietin in younger male patients and females. Adverse changes on serum lipid levels are a side effect of androgen administration. In sub- jects with normal renal function, androgens can lower the high-density lipoprotein (HDL) choles- terol concentration (particularly HDL2) while increasing the low-density lipoprotein (LDL) cholesterol concentration) Increases in the tri- glyceride level without changes in total choles- terol have been observed during androgen treat- ment in dialyzed patients, 2'4's but the effect of androgens on other lipids and lipoproteins has not been studied in these patients. It has been recently considered that the effects of androgens on lipids, such as their potential hepatotoxicity, vary widely among these steroids depending on the type and route of administra- tion. The hepatic side effects 6 and lipid changes7-9 were found to be the most notable with those administered orally (17 alpha-alkylated andro- gens), whereas these effects or changes were minimal or absent with parenteral androgens. Nandrolone decanoate is a non-17 alpha-alkyl- ated androgen without hepatotoxic effects. The aim of this study was to determine the effects of nandrolone decanoate on the lipid pro- file in chronic hemodialysis patients. We ob- served that nandrolone decanoate induced an in- crease in the concentrations of triglycerides and apolipoprotein B and a decrease in the concentra- tions of lipoprotein(a) [Lp(a)], HDL cholesterol, and apolipoprotein A-I. The effect of nandrolone decanoate on Lp(a) in uremic patients has not been previously reported, and may represent a therapeutic alternative for reducing high Lp(a) concentrations in selected patients. MATERIALS AND METHODS Our anemia protocolin chronichemodialysispatients pro- vides for the use of androgens in male patients aged -> 50 From the Servicio de Nefrologfa and Servicio de Bioqufmica-lnvestigaci6n, Hospital Ramdn y Cajal, Madrid, Spain. Received July 16, 1996; accepted in revised form Decem- ber 10, 1996. Supported by grants from the Fondo de lnvestigaci6n Sani- taria (F1S 94/0484), Spain. Address reprint requests to Jos~ L. Teruel, MD, Servicio de Nefrolog{a, Hospital Ramdn y Cajal, Carretera de Col- menar km 9.100, 28034 Madrid, Spain. © 1997 by the National Kidney Foundation, Inc. 0272-6386/97/2904-001353.00/0 American Journal of Kidney Diseases, Vol 29, No 4 (April), 1997: pp 569-575 569