Influence of megestrol acetate on nutrition, inflammation and quality of life in dialysis patients

Malnutrition is a common clinical problem in dialysis patients. The objective of this study was to evaluate the efficacy and safety of megestrol acetate in malnourished dialysis patients. Thirty-two hypoalbuminemic dialysis patients took 160 mg of megestrol acetate daily for up to 6 months. We measured height, dry weight, BMI, modified Subjective Global Assessment (SGA) score, and serum albumin, triglycerides, total cholesterol, hsCRP, IL-1 beta and IL-6 concentrations. We used validated questionnaires to evaluate selected dimensions of the quality of life. Only 12 patients completed the study. All patients reported improved appetite, and there were concurrent statistically significant increases in weight, BMI, SGA and albumin concentration (P < 0.05). For the 12 patients who completed 6 months of treatment the increase in these parameters was from 63.26 +/- A 13.04 to 65.58 +/- A 12.53 kg, from 23.5 +/- A 3.8 to 24.66 +/- A 4.23 kg/m(2), from 5.16 +/- A 0.94 to 6.16 +/- A 0.72 points, and from 36.45 +/- A 1.82 to 40.33 +/- A 2.71 g/l, respectively. However, there were no significant changes in the levels of inflammatory markers and in quality of life. Side effects included overhydration, excessive weight gain and hyperglycaemia. Megestrol acetate may be effective in reversing poor appetite in carefully selected maintenance dialysis patients, but it might not reduce inflammation or improve the quality of life. Because of the potential side effects, close monitoring is essential.