Apr. 15, 1999 Patients with kidney disease frequently experience malnutrition and an accompanying loss of muscle mass as a result of their illness and its lifesaving treatment called dialysis. These negative side effects are particularly concerning because they have been associated with increased mortality. However, a new study indicates that the use of anabolic steroids appears to increase lean body mass and significantly reduce fatigue (another common side effect) in kidney disease patients receiving dialysis.
A team of University of California San Francisco researchers, led by Kirsten L. Johansen, M.D., UCSF assistant professor of medicine, epidemiology & biostatistics, studied a group of patients who were receiving dialysis and were suffering from malnutrition.
In a randomized, double blind trial, 29 patients were given either the anabolic steroid nandrolone decanote or a placebo (dummy medication) for a six-month period. All of the patients were receiving dialysis treatments at San Francisco General Hospital. At the end of the trial, patients receiving the anabolic steroid gained an average of 5.7 pounds more lean body mass than the patients who got the placebo. Also, the patients who received the steroid reported less fatigue and scored better on physical performance tests. The researchers' results are published in the April 14 issue of the Journal of the American Medical Association (JAMA).
Hemodialysis, the most common form of dialysis in the United States, is a medical procedure employed when a patient's kidneys cannot properly clean the blood of toxins and waste products. A patient's blood is removed from the body via a tube inserted in a vein, filtered by a dialysis machine, and then replaced. Typically, this process must be repeated three times a week and takes three to four hours. In some cases, dialysis is considered a "bridge" while the patient is awaiting a kidney transplant - which can be up to a three year wait in the US. However for some patients, the blood cleansing procedure is a permanent aspect of their lives.
Physicians have tested different therapies to improve the nutritional status of dialysis patients and combat wasting, such as injections of human growth hormone or adding a liquid supplement to the patient's blood before it is returned to the body. There are serious drawbacks to the treatments, however, such as dangerous side effects and prohibitive costs. As a result, these therapies are usually restricted to only the very sickest patients.
"We felt that stimulating an increase of lean body mass was a sound approach but realized we needed a medication that was widely available, affordable, and produced fewer side effects," says Johansen, who is now director of dialysis at the San Francisco Veterans Affairs Medical Center. The team settled on nandrolone decanoate, which is sometimes used illicitly (and in much higher doses) by athletes to bulk up. In the past, anabolic steroids had been used to treat anemia in patients with severe kidney disease but their ability to build lean body mass in dialysis patients had never been tested.
According to Johansen, the number of patients requiring dialysis increases approximately seven to nine percent every year and the average age of patients is rising. Johansen says her groups' findings indicate nandrolone decanoate therapy may have an important positive impact on the physical capabilities and quality of life for dialysis patients of all ages.
Co-investigators on this study were Kathleen Mulligan, Ph.D., UCSF assistant professor of medicine, and Morris Schambelan, M.D., UCSF professor of medicine, both of the Division of Endocrinology in the Department of Medicine at San Francisco General Hospital Medical Center, which is affiliated with UC San Francisco.
The study was supported by grants from the National Center for Research Resources, the National Institute of Diabetes and Digestive and Kidney Diseases, and the Bay Area Nutrition Center.
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