title: Subcutaneous ghrelin enhances acute food intake in malnourished patients who receive maintenance peritoneal dialysis: a randomized, placebo-controlled trial.
abstract: Anorexia and malnutrition confer significant morbidity and mortality to patients with end-stage kidney disease but are resistant to therapy. The aim of this study was to determine whether subcutaneous administration of ghrelin, an appetite-stimulating gut hormone, could enhance food intake in patients who are receiving maintenance peritoneal dialysis and have evidence of malnutrition. The principal outcome measure was energy intake during a measured study meal. Secondary outcome measures were BP and heart rate and 3-d food intake after intervention. Nine peritoneal dialysis patients with mild to moderate malnutrition (mean serum albumin 28.6 +/- 5.0 g/L, total cholesterol 4.4 +/- 0.6 mmol/L, subjective global assessment score of 5.7 +/- 1.7) were given subcutaneous ghrelin (3.6 nmol/kg) and saline placebo in a randomized, double-blind, crossover protocol. Administration of subcutaneous ghrelin significantly increased the group mean absolute energy intake, compared with placebo, during the study meal (690 +/- 190 versus 440 +/- 250 kcal; P = 0.0062). When expressed as proportional energy increase for each individual, ghrelin administration resulted in immediate doubling of energy intake (204 +/- 120 versus 100%; P = 0.0319). Administration of ghrelin maintained a nonsignificant increase in energy intake over 24 h after intervention (2009 +/- 669 versus 1579 +/- 330 kcal) and was not followed by subsequent underswing (1790 +/- 370 versus 1670 +/- 530 and 1880 +/- 390 versus 1830 +/- 530 kcal on days 2 and 3, respectively). Ghrelin administration resulted in a significant fall in mean arterial BP (P = 0.0030 by ANOVA). There were no significant adverse events during the study. Subcutaneous ghrelin administration enhances short-term food intake in dialysis patients with mild to moderate malnutrition.
authors.affiliation: Renal Services, Ground Floor Pilot Wing, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK.
authors.forename: Katie
authors.initials: K
authors.lastname: Wynne
authors.forename: Kalli
authors.initials: K
authors.lastname: Giannitsopoulou
authors.forename: Caroline J
authors.initials: CJ
authors.lastname: Small
authors.forename: Michael
authors.initials: M
authors.lastname: Patterson
authors.forename: Gary
authors.initials: G
authors.lastname: Frost
authors.forename: Mohammad A
authors.initials: MA
authors.lastname: Ghatei
authors.forename: Edwina A
authors.initials: EA
authors.lastname: Brown
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Bloom
authors.forename: Peter
authors.initials: P
authors.lastname: Choi
mesh_terms: D000328:Adult; D019167:Appetite Stimulants / Q000008:administration & dosage*; D018592:Cross-Over Studies; D004435:Eating / Q000187:drug effects*; D005260:Female; D054439:Ghrelin; D006801:Humans; D007279:Injections, Subcutaneous; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D044342:Malnutrition / Q000188:drug therapy*; D008875:Middle Aged; D036361:Peptide Hormones / Q000008:administration & dosage*; D010530:Peritoneal Dialysis
chemical_list: D019167:Appetite Stimulants; D054439:Ghrelin; D036361:Peptide Hormones