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Sir,We read with interest the recent thorough review of use ofandrogen therapy in the management of renal anaemia [1].We have been interested in the role of erythropoietin andi.v. iron in the correction of the anaemia seen in patientswith congestive heart failure (CHF) [2–6]. Most of thesepatients also have chronic kidney insufciency (CKI). In 223such cases, we attempted to correct their anaemia with thecombination of up to 10000IU erythropoietin (EPO) givensubcutaneously once weekly, and i.v. Venofer (ferric sucrose)given once weekly. We gave the Venofer until either thehaemoglobin (Hb) reached target, the per cent transferrinsaturationreached35%ortheserumferritinreached700ug/l,whichever came rst. We encountered 19 cases (8.5%) (meanage 74.0±6.9 years) (14 males/ve females) that failed toreach a target Hb of 13g/dl over at least 4 months of thistreatment, the Hb increasing from a mean of 10.1±1.2 to11.1±0.8g/dl. In these 19 cases we administered nandrolonedecanoate(ND)200mg(oneampoule)onceweeklyi.m.whilecontinuing the EPO–Fe combination until the target Hbwas reached. One male patient developed a skin rash within24h after the rst dose and was removed from the study.In the remaining 18 cases the mean Hb increased over thenext 3 months from 11.1±0.8 to 13.3±0.8g/dl (P<0.01).All the patients reached the target Hb by 3 months afterND treatment was started. None of the 18 patients, maleor female, complained of any side effects and most notedan increase in appetite. There were no signicant changes inserum cholesterol, HDL, LDL, triglycerides, liver functiontests or blood pressure. Subsequently the patients no longerrequired further ND and weremaintained onEPO andi.v. Feas needed. We agree with Navarro that in patients withanaemia and CKI who do not reach target Hb with largedoses of EPO and i.v. Fe the short-term addition of ND mayrapidly correct the anaemia with minimal side effects. NDseemstobeausefuladjuvantinpatientsreceivingEPOforthecorrection of the anaemia of renal and heart failure who areresistant to therapy.

The use of androgens in anaemia resistant to erythropoietin and i.v. iron in patients with heart and renal failure