increase appetite and weight in patients with cancer or acquired .... Interventions to treat malnutrition in dialysis pa- tients include .... regular intervals in the clinic.
Advances in Peritoneal Dialysis, Vol. 20, 2004
Olga Costero, M. Auxiliadora Bajo, Gloria del Peso, Fernando Gil, Abelardo Aguilera, Silvia Ros, Covadonga Hevia, Rafael Selgas
Anorexia and malnutrition are common complications and powerful predictors of morbidity and mortality in peritoneal dialysis (PD) patients. Megestrol acetate (MA) is a progestogen that has been demonstrated to increase appetite and weight in patients with cancer or acquired immunodeficiency syndrome. To determine whether MA might benefit PD patients, we treated 32 patients with 160 mg MA daily. Treatment lasted a mean of 5.93 ± 5.12 months (range: 1 – 23 months). In 68.8% of the patients, appetite improved. Weight gain was statistically significant starting in the third month (initial weight: 66.5 ± 11.4 kg; weight at third month: 68 ± 10.4 kg; p < 0.05). We observed a nonsignificant increase in serum albumin at the third treatment month (initial serum albumin: 3.44 ± 0.27 g/L; serum albumin at third month: 3.54 ± 0.27 g/L; p = 0.45). No side effects were observed. Our experience suggests that treatment with 160 mg MA daily in PD patients leads to an increase in appetite, serum albumin, and weight gain in most patients, with no negative side effects. Key words Megestrol acetate, malnutrition, anorexia Introduction Anorexia and malnutrition are common complications and powerful predictors of morbidity and mortality in peritoneal dialysis (PD) patients (1,2). Treatment modifications that can help to prevent or treat malnutrition are adequate dialysis dose, avoidance of acidemia, and addition of food supplements. More experimental forms of nutrition therapy (3,4) include dialytic nutrition, appetite stimulants [for example, megestrol acetate (MA)], and growth factors (anabolic recombinant human growth hormone or insulin-like growth factor I). From: Department of Nephrology, University Hospitals La Paz and La Princesa, Madrid, Spain.
Treatment of Anorexia and Malnutrition in Peritoneal Dialysis Patients with Megestrol Acetate The appetite stimulant MA is a semi-synthetic steroid progestogen that was originally used as therapy in metastatic breast and endometrial cancer. What was originally considered the most frequent side effect of MA treatment—increased appetite and body weight—has gradually become an established treatment for malnutrition in patients with acquired immunodeficiency syndrome or non hormonal– responsive cancer (5,6). The four published studies that evaluated MA in end-stage renal disease (ESRD) populations (3,7,8,9) had varying results and conclusions. Our purpose in the present study was to (A) determine whether MA increases appetite and improves parameters of nutrition in PD patients and (B) explore the required dose and MA side effects. Patients and methods Between January 1995 and March 2001, we retrospectively recruited 163 PD patients from our PD unit. Within that cohort, we treated 32 patients who had anorexia and malnutrition with 160 mg MA daily. We evaluated whether MA increased appetite and weight, and whether it improved these parameters of nutrition: serum albumin, cholesterol, triglycerides, lymphocyte count, transferrin, and protein catabolic rate (PCR). We also recorded the appearance of any side effects. Table I shows demographic information, Kt/V, and causes of ESRD for the 32 study patients (19 men, 13 women; 19 on continuous ambulatory PD, 13 on automated PD). Median age of the patients was 64.19 ± 13.8 years. The initial Kt/V for the group was 2.14 ± 0.56. Twenty patients were receiving erythropoietin treatment. Statistical analysis Results for normally distributed continuous variables are expressed as mean ± standard deviation, and p
