title: The Efficacy and Safety of Megestrol Acetate in Protein-Energy Wasting due to Chronic Kidney Disease: A Systematic Review.
abstract: To assess the efficacy and safety of oral megestrol acetate (MA) in the management of protein-energy wasting in patients with chronic kidney disease (CKD).
  
  
  
  A systematic review of English published literature from 1970 until April 1, 2014.
  
  
  
  All adult patients with CKD including both dialysis and non-dialysis-dependent.
  
  
  
  Oral MA.
  
  
  
  Efficacy outcomes included changes in body weight, serum albumin, and appetite. Safety outcomes examined included adverse events (AEs) and deaths.
  
  
  
  A total of 9 studies met the inclusion criteria. No data on MA in non-dialysis CKD patients were available. Statistically significant increases in body weight (range 1.5-5 kg) were reported in 6 trials. Statistically significant increases in albumin (range of 0.22 g/dL-0.52 g/dL) were observed in 5 trials. Improved appetite was observed in 7 trials. All trials were limited by small sample sizes (range 9-32 subjects), short duration (range 8-24 weeks), a high degree of bias, and absence of clinical outcomes such as quality of life or hospitalizations. Forty-seven AEs were reported and included overhydration/excessive fluid gain, diarrhea, hyperglycemia, excessive weight gain, suppressed cortisol levels, thrombophlebitis, nausea/vomiting, confusion/hallucinations, vaginal bleeding, headache/dizziness, and elevated lactate dehydrogenase. There were 26 discontinuations due to death.
  
  
  
  The current evidence for treatment with MA in patients receiving dialysis is sparse with few high-quality trials. The safety of using MA beyond 24 weeks is unknown, and use of MA is associated with significant AEs. At this time, oral MA should be used with significant caution, and only when other treatment options are unavailable.
authors.affiliation: College of Pharmacy, University of Manitoba, Winnipeg, MB, Canada; Pharmacy Program, Winnipeg Regional Health Authority, Winnipeg, MB, Canada; Manitoba Renal Program, Manitoba, Canada. Electronic address: Lwazny@hsc.mb.ca.
authors.forename: Lori D
authors.initials: LD
authors.lastname: Wazny
authors.affiliation: Manitoba Renal Program, Manitoba, Canada.
authors.forename: Stewart
authors.initials: S
authors.lastname: Nadurak
authors.affiliation: Pharmacy Program, Winnipeg Regional Health Authority, Winnipeg, MB, Canada; Manitoba Renal Program, Manitoba, Canada.
authors.forename: Cali
authors.initials: C
authors.lastname: Orsulak
authors.affiliation: University of Manitoba, Health Sciences Libraries, Winnipeg, MB, Canada.
authors.forename: Lori
authors.initials: L
authors.lastname: Giles-Smith
authors.affiliation: Departments of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Manitoba Renal Program, Manitoba, Canada.
authors.forename: Navdeep
authors.initials: N
authors.lastname: Tangri
mesh_terms: D001066:Appetite; D019167:Appetite Stimulants; D001835:Body Weight; D006801:Humans; D019290:Megestrol Acetate / Q000009:adverse effects* / Q000627:therapeutic use*; D009752:Nutritional Status; D011788:Quality of Life; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000503:physiopathology; D012709:Serum Albumin / Q000032:analysis; D016896:Treatment Outcome; D019282:Wasting Syndrome / Q000188:drug therapy* / Q000209:etiology; D015430:Weight Gain
chemical_list: D019167:Appetite Stimulants; D012709:Serum Albumin; D019290:Megestrol Acetate