Megestrol Acetate as a Treatment for Anorexia in Hemodialysis Patients
DOI:
https://doi.org/10.6000/1929-5634.2014.03.02.3Keywords:
Anorexia, Hemodialysis, Malnutrition, Megestrol acetateAbstract
Background: The aim of this study was to evaluate the effectiveness of megestrol acetate as a treatment for anorexia in hemodialysis patients.
Materials and Methods: From 1st January 2008 to 31st December 2010, 29 patients in our Hemodialysis Unit were treated with megestrol acetate (initial dose: 160 mg / day) for anorexia associated with a decrease in dry body weight. Sixteen patients had a protein-energy wasting syndrome.
Results: Appetite improved in 25 patients, but the initial dose of megestrol acetate had to be increased in 8 patients. At three months, there was an increase in dry body weight (63.4 vs 61.9 kg, p=0.002), serum albumin level (3.98 vs 3.77 g/dl, p<0.001), serum creatinine level (10.5 vs 9.6 mg/dl, p=0.016) and protein catabolic rate (1.21 vs 0.98 g / kg / day, p < 0.001). The response was independent of the cause of anorexia. A bioelectrical impedance analysis, carried out in 9 patients, showed that treatment with megestrol acetate increased the body cell mass and changed the distribution of body water by increasing intracellular water. The megestrol acetate treatment was well-tolerated and no patients left the study due to side effects or adverse reactions.
Conclusions: Megestrol acetate improves appetite and nutritional parameters in anorexic patients treated with maintenance hemodialysis.
References
Burrowes JD, Larive B, Chertow GM, Cockram DB, Dwyer JT, Greene T, Kusek JW, Leung J, Rocco MV for the HEMO Study Group: Self-reported appetite, hospitalization and death in haemodialysis patients: findings from the Hemodialysis (HEMO) Study. Nephrol Dial Transplant 2005: 20: 2765-2774. http://dx.doi.org/10.1093/ndt/gfi132
Lopes AA, Elder SJ, Ginsberg N, et al. Lack of appetite in haemodialysis patients - associations with patients characteristics, indicators of nutritional status and outcomes in the international DOPPS. Nephrol Dial Transplant 2007; 22: 3538-3546. http://dx.doi.org/10.1093/ndt/gfm453
Kalantar-Zadeh K, Block G, McAllister CJ, Humphreys MH, Kopple JD. Appetite and inflammation, nutrition, anemia, and clinical outcome in hemodialysis patients. Am J Clin Nutr 2004; 80: 299-307.
López AP, Figuls MR, Cuchi GU, et al. Systematic review of megestrol acetate in the treatment of anorexia-cachexia syndrome. Pain Symptom Manage 2004; 27: 360-369. http://dx.doi.org/10.1016/j.jpainsymman.2003.09.007
Lien YH, Ruffenach SJ. Low dose megestrol increases serum albumin in malnourished dialysis patients. Int J Artif Organs 1996; 19: 147-150.
Williams JL, Perius M, Humble A, Sigler D, Urbanes A, Shapiro HS. Effects of megestrol acetate on nutritional status of malnourished hemodialysis patients. J Ren Nutr 1997: 7: 231 [Abstract] http://dx.doi.org/10.1016/S1051-2276(97)90035-2
Burrowes JD, Bluestone PA, Wang J, Pierson RN. The effects of moderate doses of megestrol on nutritional status and body composition in a hemodialysis patient. J Ren Nutr 1999; 9: 89-94. http://dx.doi.org/10.1016/S1051-2276(99)90006-7
Boccanfuso JA, Hutton M, McAllister B. The effects of megestrol acetate on nutritional parameters in a dialysis population. J Ren Nutr 2000; 10: 36-43. http://dx.doi.org/10.1016/S1051-2276(00)90021-9
Costero O, Bajo MA, del Peso G, et al. Treatment of anorexia and malnutrition in peritoneal dialysis patients with megestrol acetate. Adv Perit Dial 2004; 20: 209-212.
Rammohan M, Kalantar-Zadeh K, Liang A, Ghossein C. Megestrol acetate in a moderate dose for the treatment of malnutrition-inflammation complex in maintenance dialysis patients. J Ren Nutr 2005; 15: 345-355. http://dx.doi.org/10.1016/j.jrn.2004.10.006
Golebiewska J, Lichodziejewska-Niemierko M, Aleksandrowicz E, Majkowicz M, Lysiak-Szydlowska W, Rutkowski E. Influence of megestrol acetate on nutrition and inflammation in dialysis patients – preliminary results. Acta Biochim Pol 2009; 56: 733-737. [12] Monfared A, Heidarzadeh A, Ghaffari M, Akbarpour M. Effect of megestrol acetate on serum albumin level in malnourished dialysis patients. J Ren Nutr 2009; 19: 167-171. http://dx.doi.org/10.1053/j.jrn.2008.11.003
Yeh SS, Marandi M, Thode HC, et al. Report of a pilot, doubleblind, placebo-controlled study of megestrol acetate in elderly dialysis patients with caquexia. J Ren Nutr 2010; 20: 52-62. http://dx.doi.org/10.1053/j.jrn.2009.08.005
Fernández Lucas M, Teruel JL, Burguera V, et al. Tratamiento de la anorexía urémica con acetato de megestrol. Nefrología 2010; 30: 646-652.
Burrowes JD, Larive B, Cockram DB, et al. Effects of dietary intake, appetite, and eating habits on dialysis and non-dialysis treatment days in hemodialysis patients: cross-sectional results from the HEMO study. J Ren Nutr 2003; 13: 191-198. http://dx.doi.org/10.1016/S1051-2276(03)00069-4
Fouque D, Kalantar-Zadeh K, Kopple J, et al. A proposed nomenclature and diagnostic criteria for protein-energy wasting in acute and chronic kidney disease. Kidney Int 2008; 73: 391-398. http://dx.doi.org/10.1038/sj.ki.5002585
Sargent JA. Control of dialysis by a single-pool urea model: The National Cooperative Dialysis Study. Kidney Int Suppl 1983; 13: S19-S25.
Leinung MC, Liporace R, Miller CH. Induction of adrenal suppression by megestrol acetate in patients with AIDS. Ann Intern Med 1995; 122: 843-845. http://dx.doi.org/10.7326/0003-4819-122-11-199506010-00006
Mann M, Koller E, Murgo A, Malozowski S, Bacsanyi J, Leinung M. Glucocorticoid activity of megestrol. A Summary of Food and Drug Administration Experience and a Review of the Literature. Arch Intern Med 1997; 157: 1651-1656. http://dx.doi.org/10.1001/archinte.1997.00440360053005
Downloads
Published
How to Cite
Issue
Section
License
Policy for Journals/Articles with Open Access
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are permitted and encouraged to post links to their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work
Policy for Journals / Manuscript with Paid Access
Authors who publish with this journal agree to the following terms:
- Publisher retain copyright .
- Authors are permitted and encouraged to post links to their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work .
