Anabolic steroids in the treatment of malnourished CAPD patients: a retrospective study.

Objective: To assess the effect of anabolic steroids on malnutrition of continuous ambulatory peritoneal dialysis (CAPD) patients.

Design: Retrospective analysis of medical records, charts, and computer-generated laboratory and medication data.

Setting: Peritoneal Dialysis Unit of The Toronto Hospital.

Patients: Thirteen patients with moderate to severe malnutrition who had received nandrolone decanoate (ND) intramuscularly (IM) for at least three months. Nine of these patients (group A), with a mean age of 59.4 years, received only ND (100-200 mg IM monthly). Group B consisted of 4 patients (mean age 74.0 years) who, in addition to ND, received intraperitoneal (IP) amino acids.

Results: In group A, serum albumin, while declining before ND treatment (34.4 +/- 3.2 to 31.5 +/- 3.35, x +/- SEM, g/L at -2 and 0 months), showed a progressive and significant (p < 0.001) increase during treatment, sustained up to the third month (36.57 +/- 1.51). In group B, serum albumin did not increase significantly (30.25 +/- 2.62, 30.75 +/- 1.9, and 31.5 +/- 4.8, mean +/- SEM, g/L at -2, 0, and +3 months, respectively. In group A, serum creatinine was increased significantly (p < 0.01) from 0 to +3 months (731 +/- 185 to 938 +/- 92.5 mmol/L). Blood urea, bicarbonate, and total protein levels did not change significantly. In group B, serum creatinine fluctuated considerably with an insignificant trend to rise. Blood urea showed a steady trend to increase without reaching statistical significance. In relation to time 0, bicarbonate levels (28.7 +/- 3.3) were decreased significantly (p < 0.05) (27 +/- 0.8, 24.6 +/- 1.5, and 25 +/- 1 mEq/L, at +1, +2, and +3 months, respectively).

Conclusions: Nandrolone decanoate alone, in relatively low doses, exerted a definite anabolic effect in 9 malnourished CAPD patients. The lack of a similar effect in 4 patients, who in addition to ND received amino acids IP, could be explained by the low dose of ND, the concurrent acidosis, the severity of malnutrition, and the older age of this group.