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Anabolic Effects of Nandrolone Decanoate in Patients Receiving Dialysis
A Randomized Controlled Trial
Kirsten L. Johansen, MD;
Kathleen Mulligan, PhD;
Morris Schambelan, MD
JAMA. 1999;281:1275-1281.
Context Patients receiving dialysis commonly experience malnutrition, reduced muscle mass (sarcopenia), and fatigue for which no effective treatment has been identified. Anabolic steroids are known to increase muscle mass and strength in healthy individuals, but their effect on the sarcopenia and fatigue associated with long-term dialysis has not been evaluated.
Objective To assess the effects of an anabolic steroid, nandrolone decanoate, on lean body mass (LBM), functional status, and quality of life in dialysis patients.
Design Randomized, double-blind, placebo-controlled trial conducted between April 1996 and July 1997.
Setting Hospital-based outpatient dialysis unit.
Patients Twenty-nine patients undergoing dialysis for at least 3 months.
Intervention Nandrolone decanoate, 100 mg (n = 14), or placebo (n = 15) by intramuscular injection once a week for 6 months.
Main Outcome Measures Weight, LBM, fatigue, grip strength, walking and stair-climbing times, and treadmill performance after 3 and 6 months of treatment.
Results Lean body mass increased significantly in patients given nandrolone compared with patients given placebo (mean change [SD], +4.5 [2.3] kg; P<.001 compared with baseline). This effect was significantly greater than the change in LBM in the placebo group (mean change [SD], +1.9 [1.6] kg; P = .003 compared with baseline; P = .005 compared with nandrolone group). Serum creatinine levels increased in the nandrolone group (+168 [203] mmol/L [1.9 {2.3} mg/dL]; P = .02) but not in the placebo group (-4.0 [177] mmol/L [0.04 {2.0} mg/dL]; P = .95), suggesting an increase in muscle mass. Time to complete the walking and stair-climbing test decreased from 36.5 to 32.7 seconds in the nandrolone group, while those in the placebo group increased from 38.7 to 42.1 seconds (P = .05). Peak oxygen consumption increased in the individuals in the nandrolone group who performed treadmill tests, but not to a statistically significant degree. Grip strength did not change in either group.
Conclusions Treatment with nandrolone for 6 months resulted in a significant increase in LBM associated with functional improvement in patients undergoing dialysis.
Author Affiliations: Divisions of Nephrology (Dr Johansen) and Endocrinology (Drs Mulligan and Schambelan), Department of Medicine, San Francisco General Hospital, University of California, San Francisco.
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