- Design
- Systematic review and meta-analysis of 15 RCTs (1974–2021)
- Population
- Adults with CKD
- Primary outcome
- Lean body mass, haemoglobin, haematocrit
- Effect
- Lean mass +2.63 kg (1.60–3.65); Hb +0.81 g/dL (very low certainty)
This meta-analysis pooled 15 randomised trials of intramuscular nandrolone decanoate in adults with CKD, published between 1974 and 2021. It was published in Endocrine in September.
Nandrolone increased lean body mass by 2.63 kg (95% CI 1.60 to 3.65; 4 trials, 125 patients). Haemoglobin (+0.81 g/dL) and haematocrit (+3.1%) also favoured nandrolone, but with substantial heterogeneity and very low certainty. Quality of life effects were inconsistent and long-term safety data were sparse.
Most of these trials predate current erythropoiesis-stimulating agents and HIF stabilisers. Nandrolone is not a substitute for them, and its role in modern CKD care is unknown.
- Do not use nandrolone in place of standard anaemia treatment in CKD.
- Address protein-energy wasting with diet and dialysis adequacy first.
- Be aware of androgenic, hepatic and lipid effects if used.
Why it matters
It is still used for wasting and anaemia in some settings, and the evidence behind it is thin.
Don't overread it
Very low-certainty, largely pre-2000 evidence cannot support nandrolone for anaemia.
The statistics, in plain English
The lean-mass estimate rests on four trials and 125 patients. The haemoglobin estimate is very low certainty, meaning the true effect may be substantially different.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for nephrology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free