Megestrol acetate in a moderate dose for the treatment of malnutrition-inflammation complex in maintenance dialysis patients.
BACKGROUND
Malnutrition-inflammation complex syndrome and anorexia, common conditions in maintenance dialysis patients, are strongly associated with higher mortality and hospitalization and lower quality of life (QoL) in this population. Megestrol acetate, 800 mg/day, has been shown to increase appetite and food intake and to mitigate inflammation in cachectic AIDS and cancer patients, leading to weight gain, but it is also associated with side effects at this dose.


METHODS
We evaluated the efficacy of the oral solution of megestrol acetate in half of its conventional dose in improving the nutritional state and inflammation in 10 hypoalbuminemic dialysis patients (albumin < 3.7 g/dL). Six women and 4 men, ages 60.2 years, took 400 mg of megestrol acetate solution daily for 16 weeks. Anthropometry, dual energy x-ray absorptiometry, 24-hour diet recalls, and biochemical measurements of nutrition and inflammation, including serum C-reactive protein and leptin, were performed.


RESULTS
At the end of the 16 weeks of intervention, weight and body mass index increased by 9%, body fat proportion by 31%, and triceps skinfold by 40% (P < .01). Serum albumin increased from 3.0 to 3.3 g/dL and continued to increase significantly to 3.6 g/dL after 3 months postintervention (P = .03). Serum leptin increased from 5.2 to 10.7 ng/mL (P = .09). Daily protein and energy intake increased progressively up to 27% to 42% by the end of the trial (P < or = .01). In 8 patients without acute infection, serum C-reactive protein declined from 1.24 to 0.78 mg/L (P = .06). QoL and appetite were reported to be improved. No major side effects were observed, and all 10 patients completed the 16 weeks of daily intake of megestrol acetate without interruption.


CONCLUSIONS
Megestrol acetate oral solution in half of its conventional dose is safe and improves the nutritional state, inflammation, and anorexia in maintenance dialysis patients. Larger-scale placebo-controlled randomized studies are needed to confirm the beneficial effects of 400 mg/day of megestrol acetate in dialysis patients.
Rammohan
Meenakshi
M
General Clinical Research Center, Division of Nephrology, Hypertension, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. mrammoha@nmh.org
Kalantar-Zadeh
Kamyar
K
Liang
Alexander
A
Ghossein
Cybele
C
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000855:Anorexia / Q000150:complications / Q000188:drug therapy; D000886:Anthropometry; D001823:Body Composition; D015992:Body Mass Index; D001835:Body Weight; D002097:C-Reactive Protein / Q000032:analysis; D004044:Dietary Proteins / Q000008:administration & dosage; D002149:Energy Intake; D005260:Female; D006801:Humans; D034141:Hypoalbuminemia / Q000150:complications; D007249:Inflammation / Q000150:complications / Q000188:drug therapy*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D020738:Leptin / Q000097:blood; D008297:Male; D019290:Megestrol Acetate / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D009752:Nutritional Status; D011446:Prospective Studies; D011502:Protein-Energy Malnutrition / Q000150:complications / Q000188:drug therapy*; D006435:Renal Dialysis; D012709:Serum Albumin / Q000032:analysis; D013577:Syndrome; D016896:Treatment Outcome
D004044:Dietary Proteins; D020738:Leptin; D012709:Serum Albumin; D002097:C-Reactive Protein; D019290:Megestrol Acetate