Effects of nandrolone decanoate on lean body mass and anemia in adults with chronic kidney disease: a systematic review and meta-analysis.

PURPOSE: Protein-energy wasting, sarcopenia, and anemia are common complications of chronic kidney disease (CKD) and are associated with poor outcomes. This systematic review and meta-analysis evaluated the effects of nandrolone decanoate on lean body mass and hematologic parameters in adults with CKD. METHODS: We searched PubMed/MEDLINE, CENTRAL, Embase, and LILACS up to February 18, 2026, for randomized controlled trials of intramuscular nandrolone decanoate in adults with CKD. Primary outcomes were lean body mass, hemoglobin, and hematocrit. Risk of bias and certainty of evidence were assessed using RoB 2 and GRADE, respectively. RESULTS: Fifteen RCTs published between 1974 and 2021 were included. Nandrolone decanoate was associated with increased lean body mass (4 trials; n = 125; MD 2.63 kg, 95% CI 1.60-3.65). Pooled estimates for hemoglobin (6 trials; n = 239; MD 0.81 g/dL) and hematocrit (7 trials; n = 198; MD 3.12%) also favored nandrolone, but were limited by substantial heterogeneity and very low certainty of evidence, precluding firm conclusions. Quality-of-life effects were inconsistent, and long-term safety data were sparse. CONCLUSION: Nandrolone decanoate was associated with increased lean body mass in adults with CKD. However, the evidence base is largely historical, and substantial heterogeneity and very low certainty of evidence preclude firm conclusions regarding hematologic benefits. Contemporary randomized trials are needed to clarify whether nandrolone has any role in current CKD management.