[Treatment of uraemic anorexia with megestrol acetate].
BACKGROUND
Anorexia is a common disorder in patients treated with regular haemodialysis and is a contributing factor to malnutrition. The aim of this study was to evaluate the effectiveness of megestrol acetate, an appetite stimulant used in cancer patients, as a treatment for anorexia in dialysis patients.


METHODS
In 2009, 16 patients in our haemodialysis unit, three with diabetes mellitus, were treated with megestrol (160 mg/day single dose) for anorexia defined according to a Likert scale of appetite. The schedule and dialysis dose were not changed during the study.


RESULTS
In the third month of treatment there was, in the overall group, an increase in dry weight (60.8 vs 58.9 kg, P<.01), in albumin concentration (4.02 vs 3.8 g/dl, P<.05), in creatinine concentration (9.73 vs 8.26 mg/dl, P<.01), and protein catabolic rate (1.24 vs. 0.97 g/kg/day, P<.0001). Non-significant variations in the concentration of haemoglobin, erythropoietin dose, and lipid concentrations were found. One patient with diabetes mellitus had to increase the dose of insulin and two other patients suffered mild hyperglycaemia. Megestrol acetate did not suppress the secretion of pituitary sex hormones, but in 3 of 10 patients studied was found inhibition of ACTH secretion. The response was not homogeneous: one patient did not respond and reduced his dry weight, in 5 the weight gain was minimal (less than 1 kg) and in the remaining ten the response was good, with an increase in dry weight ranging between 1.5 and 5.5 kg.


CONCLUSIONS
Megestrol acetate can improve appetite and nutritional parameters in patients treated with periodic haemodialysis who report anorexia. Megestrol acetate may induce hyperglycaemia and inhibit the secretion of ACTH in some patients. These side effects should be assessed when administering this treatment.
Servicio de Nefrología, Hospital Ramón y Cajal, Madrid. mfernandez.hrc@salud.madrid.org
M
M
Fernández Lucas
J L
JL
Teruel
V
V
Burguera
H
H
Sosa
M
M
Rivera
J R
JR
Rodríguez Palomares
R
R
Marcén
C
C
Quereda
D000324:Adrenocorticotropic Hormone / Q000378:metabolism; D000855:Anorexia / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D019167:Appetite Stimulants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001835:Body Weight / Q000187:drug effects; D003404:Creatinine / Q000097:blood; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications / Q000188:drug therapy; D003928:Diabetic Nephropathies / Q000097:blood / Q000150:complications / Q000628:therapy; D004305:Dose-Response Relationship, Drug; D004341:Drug Evaluation; D006801:Humans; D006943:Hyperglycemia / Q000139:chemically induced; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use; D019290:Megestrol Acetate / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D011506:Proteins / Q000378:metabolism; D006435:Renal Dialysis / Q000009:adverse effects*; D012189:Retrospective Studies; D012709:Serum Albumin / Q000032:analysis; D014511:Uremia / Q000097:blood / Q000150:complications* / Q000628:therapy
D019167:Appetite Stimulants; D007328:Insulin; D011506:Proteins; D012709:Serum Albumin; D000324:Adrenocorticotropic Hormone; D003404:Creatinine; D019290:Megestrol Acetate