| [ Summary ] |
In clinical practice, there are few drugs available for the treatment of sarcopenia in patients receiving regular dialysis. Anabolic steroids are the only drugs which are applicable to patients with chronic kidney disease and whom exhibit severe wasting conditions. However, these agents have many serious adverse effects including virilism, liver dysfunction, progression of cardiovascular disease and worsening of prostate cancer. As a result, the European Best Practice Guidelines (EBPG) on nutrition recommend that a course of androgens should be considered for three to six months in malnourished hemodialysis (HD) patients at evidence level II. Although L-carnitine supplementation is reported to be useful for sarcopenia in patients with advanced pancreatic cancer, its effectiveness is still unknown for dialysis patients. Recently, new agents have been developed such as an anti―myostatin receptor peptibodies. These are non-steroidal selective androgen receptor modulators, or oral ghrelin-receptor agonists. Preclinical studies have demonstrated that these agents could provide favorable levels of safety and beneficial effects on muscle wasting in the elderly and in patients with cancer induced cachexia. A randomized, double-blind pilot study is being conducted to examine the effects of anti-myostatin peptibodies (PINTA 745) on muscle composition in HD patients who experience protein-energy wasting. The results of this trial are anticipated. |