혈액투석 환자에서 저용량 Megestrol Acetate 복용이 영양학적 지표에 미치는 영향 = Low Dose Megestrol Acetate for Maintenance Hemodialysis Patients

다국어 초록 (Multilingual Abstract)

Purpose:Maintenance hemodialysis (HD) patients have a high prevalence of malnutrition and inflammation. Megestrol acetate (MA) has been shown to increase appetite in cancer patients but the usual dose of MA (400-800 mg/day) was associated with serious side effects in HD patients. We evaluated the changes in nutritional and inflammatory parameters after low dose of MA treatment in malnourished HD patients
Methods:Inclusion criteria were maintenance HD patients who showed serum albumin <3.5 g/dL or <4.0 g/dL with anorexia. Serum chemical parameters, cytokines, Subjective Global Assessment, dry weight, Kt/V, nPCR, SF36 quality of life, fat free mass (FFM), and body fat mass (BFM) were measured. Patients were instructed to take 5 mL (200 mg) of MA solution once a day.
Results:Fourteen patients (seven male, age 52±10 years, mean HD duration 48±59 months) were included. One patient died of pneumonia. Seven patients dropped out because they refused to take the drug after one to three months of treatment; two of them complained of thirst, three of them ate too much, and two had both. Six patients (four male and two female) have completed six months of study. Serum albumin (3.1±0.5 to 3.6±0.4 g/dL), TIBC (184.2±27.9 to 205.0±25.8 μg/ dL), BFM (11.9±5.7 to 16.6±7.4 kg), protein intake (57.0±32.5 to 68.7±39.2 g/day), and energy intake (1,521± 690 to 1,724±879) were increased. Serum CRP and IL-6 decreased without statistical significance. No significant adverse effects were observed in all patients who had completed study.
Conclusion:Low dose MA can improve the nutritional status, inflammation, and anorexia in maintenance HD patients.

국문 초록 (Abstract)

목 적:유지 혈액투석 환자에서 영양실조와 염증의 유병률은 높다. Megestrol Acetate (MA)는 암환자에서 식욕 증진 효과를 보였다. 이전에 말기신부전 환자에서 MA를 일일 400에서 800 mg 사용하였을 때 심각한 부작용들이 발생하였다. 저자들은 저용량의 MA를 영양실조 상태인 혈액 투석 환자에서 투약하여 영양학적, 염증 지표들의 개선 효과를 알아보고자 하였다.
방 법:유지 혈액투석 환자 중 혈청 알부민 치가 3.5 g/dL 미만이거나 4.0 g/dL 미만이면서 식욕부진을 호소하는 환자를 대상으로 하였다. 1달 간격으로 혈청 화학 검사들, Subjective Global Assessment, 건체중, Kt/V, nPCR 등을 측정하였고, 연구 개시 전과 종료 시점인 6개월 째 SF-36 설문과 제지방량과 체지방량, 사이토카인을 측정을 하였다. 환자들에게 MA 현탁액 5 mL (200 mg)를 1일 1회 복용하도록 하였다.
결과:14명의 환자들이 선정되었다. 환자들의 평균 나이는 52±10세였고, 투석기간은 48±59개월이었고, 남녀 각각 7명씩이었다. 연구 중에 1명은 폐렴으로 사망하였다. 나머지 13명 중 2명은 구갈과 식욕 증가로 2명은 구갈로 3명은 과도한 식욕 증가로 복용을 거부하여 연구 시작 1-3개월 내에 탈락하였다. 6명 (남자 4, 여자 2)이 6개월간의 연구를 마쳤다. 알부민이 3.1±0.55에서 3.6±0.35 g/dL로 TIBC가 184.2± 27.9에서 205.0±25.8 ug/dL로 BFM가 11.9±5.7에서 16.6± 7.4 kg으로 증가하였다. 단백질 섭취량이 57.0±32.5에서 68.7±39.2 g/day로 섭취열량이 1,521±690에서 1,724±879 kcal/day로 증가하였다. CRP와 IL-6이 감소했지만 통계적 유의성은 없었다. 연구를 마친 환자들에서 심각한 부작용은 발생하지 않았다.
결론:유지 혈액투석 환자에서 저용량의 MA는 비교적 안전하였고, 영양학적 지표, 염증, 식욕부진을 개선시켰다.

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