Treatment of uremic anorexia with megestrol acetate

Background: Anorexia is a common disorder in patients treated with regular hemodialysis and a contributing factor of malnutrition. The aim of this study was to evaluate the effectiveness of megestrol acetate, an appetite stimulant used in cancer patients as a treatment for anorexia in dialysis patients. Material and methods: In 2009, 16 patients in our hemodialysis unit, three with diabetes mellitus were treated with megestrol (160 mg/day single dose) for anorexia defined as a Likert scale of Appetite. The pattern and dialysis dose were not changed during the study. Results: In the third month of treatment is aimed, in the total group, an increase of dry weight (60.8 vs. 58.9 kg, p <0.01), concentration of albumin (4.02 vs 3.8 g/dl, p <0.05), creatinine concentration (9.73 vs. 8.26 mg/dl, p <0.01) and protein catabolic rate (1.24 vs. 0.97 g/kg/day, p <0001). Non significant variations in the concentration of hemoglobin, erythropoietin dose, and concentration of lipids were found. One patient with diabetes mellitus had to increase the dose of insulin and two other patients have had some mild hyperglycemia. Megestrol acetate did not suppress the secretion of pituitary sex hormones, but in 3 of 10 patients studied was found inhibition of ACTH secretion. The response was not homogeneous: a patient did not respond and reduced its dry weight, 5 weight gain was quiet (less than 1 kg) and the remaining ten the response was good with an increase in dry weight ranged between 1.5 and 5.5 kg. Conclusions: Megestrol acetate can improve appetite and nutritional parameters in patients treated with periodic hemodialysis who report anorexia. Megestrol acetate can induce hyperglycemia and inhibit the secretion of ACTH in some patients. These side effects should be assessed when given this treatment.