Megestrol Acetate Improves Weight Gain in Pediatric Patients With Chronic Kidney Disease
published online 30 April 2010. Corrected Proof
Objective
Megestrol acetate (MA) has been used to treat weight loss in pediatric patients with malignancies, cystic fibrosis and HIV/AIDS. We herein report our experience with MA in pediatric patients with chronic kidney disease (CKD).
Design
We conducted a retrospective cohort study. Charts were evaluated for clinical, treatment, and laboratory data at six time points: approximately 6 months prior to initiation of MA, at initiation and cessation of MA, and at 2-, 4-, and 8-month follow-up. Anthropometric measurements were corrected for age and sex by conversion to z scores.
Setting
Division of Pediatric Nephrology, Helen DeVos Children's Hospital, Grand Rapids, MI.
Patients
Pediatric patients (n = 25) with CKD and poor weight gain.
Intervention
Patients were administered MA at initial and tapered doses of 14.4 ± 8.1 mg/kg/d and 10.1 ± 6.5 mg/kg/d, respectively, for 5.4 ± 6.3 months.
Results
The study population (n = 25) was 60% male, 16% African American, 72% white, and 12% Hispanic with a mean ± SD age of 8.9 ± 5.4 years. Prior to MA therapy, patients demonstrated a decrease in BMI and poor weight gain. The treatment phase was associated with significant increases in BMI (P < .0001) and weight (P < .0001), which were well sustained at 8-month follow-up (P < 0.01 and P < 0.001, respectively). Patients demonstrated continued increases in height. A single patient exhibited physical adverse side effects (cushingoid features) associated with MA; otherwise, MA was well tolerated.
Conclusions
MA appears to effectively improve weight gain in pediatric CKD patients with minimal adverse side effects and may therefore serve as a safe, short-term, nutritional strategy.
∗Pediatric Nephrology, Dialysis and Transplantation, Helen DeVos Children's Hospital and Michigan State University College of Human Medicine, Grand Rapids, MI
†Department of Pharmacy, Helen DeVos Children's Hospital, Grand Rapids, MI
‡Department of Family Medicine, Michigan State University College of Human Medicine, East Lansing, MI
Address reprint requests to Gina-Marie Barletta, MD, Pediatric Nephrology, Dialysis and Transplantation, Helen DeVos Children's Hospital, 221 Michigan Street NE, Suite 406, Grand Rapids, MI 49503.
D.J.H. is supported by an American Society of Nephrology Student Scholar Grant. This study was presented at the 2009 American Society of Pediatric Nephrology meeting, Baltimore, MD.
ABSTRACT