LOW-DOSE MEGESTROL INCREASES SERUM-ALBUMIN IN MALNOURISHED DIALYSIS PATIENTS

To evaluate the efficacy of low dose megestrol on malnourished dialysi s patients we treated 16 dialysis patients with persistent hypoalbumin emia (< 3.5 gml/dl for 2 consecutive months) and adequate dialysis at a dose of 20 mg orally twice daily. Twelve patients on peritoneal dial ysis and 4 on hemodialysis were followed for 4.3 +/- 0.6 m (2-11 m). W ithin one month serum albumin rose from 2.7 +/- 0.1 to 3.0 +/- 0.2 gml /dl (p < 0.05) and remained elevated at the end of follow-up (3.1 +/- 0.2, p < 0.05 vs. pre-treatment levels). In the 12 responders (increas e of albumin > 0.3 gml/dl), all of whom reported improved appetite, th e maximal increase of serum albumin in 2 months was 0.8 +/- 0.1 gml/dl (range: 0.3-1.2). Four patients did not respond (change of albumin: - 0.05 +/- 0.18, range: -0.6-0.2) because of encephalopathy, amyloidosis , depression or noncompliance. One patient stopped megestrol because o f vaginal bleeding from uterine leiomyoma. Three patients died from ca uses unrelated to the megestrol. Our preliminary study suggests that l ow dose megestrol (40 mg per day) increases serum albumin levels in 75 % of dialysis patients with malnutrition. If is well tolerated but may cause vaginal bleeding from uterine tumors.