Maintenance of the red blood cell volume is a fundamental aspect of ensuring
oxygen supply to the tissue. Recombinant human
erythropoietin (rHuEPO) was approved for marketing in Japan in 1990 for the treatment of
anemia in patients on dialysis. Recombinant human
erythropoietin caused a significant increase in
hemoglobin (Hb) levels in patients on dialysis. However, not all have a good response to rHuEPO
therapy; the causes of rHuEPO failure include
iron deficiency,
infection,
uremia, and interaction of some drugs.
Juzen-taiho-to (TJ-48), a mixture of extracts from 10 medicinal herbs, has been used traditionally to treat patients with
anemia,
anorexia, or
fatigue. To clarify the effect of
TJ-48 on
erythropoietin-resistant
anemia, we studied the effect of
TJ-48 in patients on
hemodialysis with
erythropoietin-resistant
anemia. We divided 42
end-stage renal disease patients on
hemodialysis with
erythropoietin-resistant
anemia (Hb<10.0 g/dL with rHuEPO 9000 U/wk or 15 U/kg/wk treatment) into 2 groups as follows: a TJ-48-treated group (TJ-48 group, 7.5 g/d, n=22) and a
TJ-48 nontreated (control group, n=20). At the beginning of this study, there was no significant difference between the groups in age, sex, serum
creatinine, blood
urea nitrogen, serum
iron, and
ferritin. After 12 weeks of treatment, the Hb level had significantly increased from 8.4 +/- 1.1 to 9.5 +/- 1.3 g/dL (P=0.0272) in the
TJ-48 group.
C-reactive protein (CRP) had significantly decreased from 1.4 +/- 1.7 to 0.6 +/- 0.8 mg/dL (P=0.0438). There was a significant negative correlation between Hb and CRP in the
TJ-48 group (r(2)=0.121, P=0.0066). In contrast, in the control group, Hb and CRP showed no significant changes throughout this study. Nor was there a significant correlation between Hb and CRP in the control group. In conclusion,
TJ-48 was effective in improving
erythropoietin-resistant
anemia in
end-stage renal disease patients. This effect was, at least in part, due to the anti-inflammatory effect of
TJ-48 in patients on
hemodialysis.