title: Using megestrol acetate to ameliorate protein-energy wasting in chronic kidney disease.
abstract: BACKGROUND
  Various populations are affected by chronic kidney disease (CKD), and a low dose appetite stimulant megestrol acetate (MA) is sometimes recommended in patients with CKD to ameliorate protein-energy wasting (PEW). Patients with CKD are at greater risk of developing PEW since the progression of their disease can cause decreased nutrient intake, catabolic effects, systemic inflammation and metabolic changes. Providers can detect PEW in CKD by identifying low serum levels ≤3.8 g/dl of albumin, <30 mg/dl of transthyretin, or <100 mg/dl of cholesterol. Other characteristics include BMI <22 kg/m(2) (for ≤65 years), unintentional weight loss of ≥5% in three months or ≥10% in six months, body fat percentage <10%, with muscle wasting of a reduction of ≥5% in three months or ≥10% in six months of muscle mass.
  
  
  METHODS
  A review of research was completed and data collected from small population-based retrospective studies to determine the effect of MA.
  
  
  RESULTS
  Clinical trials demonstrated the effectiveness of MA by showing increases in BMI up to 9%, albumin levels up to 1.1 g/dl, with reported protein and energy intake increases from 27% to 42%. There are potential adverse effects of using MA in CKD.
  
  
  CONCLUSIONS
  After reviewing the available literature, the benefits of using MA should be evaluated against the potential side effects. For further examination of MA's potential benefits, long-term, prospective, large clinical trials should be carried out.
authors.affiliation: Division of Nephrology, Levine Children's Hospital-Carolinas Healthcare System, Charlotte, North Carolina, USA.
authors.forename: Christine Skouberdis
authors.initials: CS
authors.lastname: Smith
authors.affiliation: Department of Human Environmental Studies, Central Michigan University, Mount Pleasant, Michigan, USA.
authors.forename: John V
authors.initials: JV
authors.lastname: Logomarsino
mesh_terms: D019167:Appetite Stimulants / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D019290:Megestrol Acetate / Q000009:adverse effects / Q000627:therapeutic use*; D011502:Protein-Energy Malnutrition / Q000188:drug therapy* / Q000209:etiology; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000188:drug therapy; D019282:Wasting Syndrome / Q000188:drug therapy* / Q000209:etiology
chemical_list: D019167:Appetite Stimulants; D019290:Megestrol Acetate
keywords: Appetite Stimulant; Chronic Kidney Disease; Megestrol Acetate; Protein energy wasting