Lien YH, Ruffenach SJ
Low dose megestrol (Megace) increases serum albumin in
malnourished dialysis patients
Int J Artif Organs
(Mar) 19:147-150 1996
Megestrol (Megace) a progestational agent structurally similar to
progesterone has been used to increase appetite and food intake in
cancer patients. In this study, which was NOT a randomized trial, but
an observational study, 16 ESRD patients (12 PD, 4 HD) with serum
albumin levels < 3.5 gm/dl for at least 2 months were given 20 mg BID
megestrol for at least 2 months. The were receiving adequate
dialysis (mean HD Kt/V 1.5, PD 2.1).
Serum albumin improved from a mean of 2.7 to a mean of 3.1 overall.
12/16 were "responders". In these patients the albumin increase was
more remarkable, averaging 0.8 gm/dl, and all 12 reported increased
appetite, although caloric intake was not formally assessed. PCRn was
not quantified, although predialysis BUN did increase, consistent with
increased protein intake. One patient had increased vaginal bleeding
during therapy which was associated with uterine leiomyomata.
Comment: Because albumin decreases have a tendency to improve
spontaneously whenever attention is paid to this problem, the results
of this study must be interpreted with caution. Follow up was short
(averaging 2 months), and there was no increase in weight.
Anthropometric nutritional parameters were not measured. So why are
we reviewing this study? Because malnutrition is a great problem in
some dialysis patients. The data presented here certainly suggest
that a more proper study should be implemented, including, placebo-
controls, with longer follow-up and with assessment of dietary intake
and other nutritional and urea kinetic indices. (John T. Daugirdas,
M.D., University of Illinois at Chicago)