HDCN Article Review/Hyperlink

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)