OBJECTIVE: To determine the safety and efficacy of moderate doses of megestrol acetate (>/=320 mg/day) in a patient on hemodialysis. DESIGN: Case study. SETTING: Chronic hemodialysis facility and body composition unit in New York City. MAIN OUTCOME MEASURES: Body weight, body composition, dietary energy and protein intake, appetite assessment, serum albumin, prealbumin, serum transferrin, and quality of life. RESULTS: The patient received megestrol acetate for 24 weeks and gained little body weight. However, his fat mass increased by 7.5 kg (163%), and fat-free mass decreased by 6.8 kg (10.6%) from baseline measurements. The proportional content of total body water, extracellular water, intracellular water, body cell mass in fat-free mass, and average cell K+ concentration were maintained within normal ranges. Serum albumin was maintained, serum transferrin increased, prealbumin decreased, dietary energy and protein intakes increased, and reported appetite improved. CONCLUSIONS: Moderate doses of megestrol acetate may be an effective therapeutic agent in reversing poor appetite, increasing dietary energy and protein intakes, and improving nutritional status in some patients receiving maintenance hemodialysis. However, these changes were at the expense of altering body composition components. Further research that includes measures of body composition, nutritional status, appetite assessment, and quality of life are needed to determine the safety and effectiveness of moderate or high doses of megestrol acetate in a large number of hemodialysis patients.
OBJECTIVE: To determine the safety and efficacy of moderate doses of megestrol acetate (>/=320 mg/day) in a patient on hemodialysis. DESIGN: Case study. SETTING: Chronic hemodialysis facility and body composition unit in New York City. MAIN OUTCOME MEASURES: Body weight, body composition, dietary energy and protein intake, appetite assessment, serum albumin, prealbumin, serum transferrin, and quality of life. RESULTS: The patient received megestrol acetate for 24 weeks and gained little body weight. However, his fat mass increased by 7.5 kg (163%), and fat-free mass decreased by 6.8 kg (10.6%) from baseline measurements. The proportional content of total body water, extracellular water, intracellular water, body cell mass in fat-free mass, and average cell K+ concentration were maintained within normal ranges. Serum albumin was maintained, serum transferrin increased, prealbumin decreased, dietary energy and protein intakes increased, and reported appetite improved. CONCLUSIONS: Moderate doses of megestrol acetate may be an effective therapeutic agent in reversing poor appetite, increasing dietary energy and protein intakes, and improving nutritional status in some patients receiving maintenance hemodialysis. However, these changes were at the expense of altering body composition components. Further research that includes measures of body composition, nutritional status, appetite assessment, and quality of life are needed to determine the safety and effectiveness of moderate or high doses of megestrol acetate in a large number of hemodialysis patients.
Authors: Robert H Mak; Alp T Ikizler; Csaba P Kovesdy; Dominic S Raj; Peter Stenvinkel; Kamyar Kalantar-Zadeh Journal: J Cachexia Sarcopenia Muscle Date: 2011-03-16 Impact factor: 12.910