Anorexia in hemodialysis patients: the possible role of des-acyl ghrelin.
BACKGROUND
Anorexia is frequently found in end-stage renal disease and is a reliable predictor of morbidity and mortality in hemodialysis (HD) patients. The pathogenesis of anorexia is complex and the appetite-modulating hormone ghrelin could be involved. Two forms of circulating ghrelin have been described: acylated ghrelin (<10% of circulating ghrelin) which promotes food intake, and des-acyl ghrelin which induces a negative energy balance. The aim of this cross-sectional study is to clarify whether anorexia and body weight change in HD patients relate to plasma des-acyl ghrelin levels.


METHODS
34 HD patients and 15 healthy controls were studied. The presence of anorexia was assessed by a questionnaire. Serum des-acyl ghrelin was measured in HD patients and in 15 body mass index-, sex- and age-matched controls by ELISA. Energy intake was assessed by a 3-day dietary diary, and fat-free mass (FFM) was evaluated by body impedance analysis. Data have been statistically analyzed and are presented as mean +/- SD.


RESULTS
14 patients (41%) were found to be anorexic, and 20 patients (59%) non-anorexic. Energy intake (kcal/day) was significantly lower in anorexic than in non-anorexic patients (1,682 +/- 241 vs. 1,972.50 +/- 490; p < 0.05). FFM (%) was lower in anorexic than in non-anorexic patients (65.8 +/- 4.4 vs. 70.9 +/- 8.7; p = 0.05). Plasma des-acyl ghrelin levels (fmol/ml) were significantly higher in HD patients than in controls (214.88 +/- 154.24 vs. 128.93 +/- 51.07; p < 0.05), and in anorexic HD patients than in non-anorexic (301.7 +/- 162.4 vs. 159.1 +/- 115.5; p < 0.01).


CONCLUSIONS
Anorexia is highly prevalent among HD patients and des-acyl ghrelin could be involved in its pathogenesis.
Muscaritoli
Maurizio
M
Department of Clinical Medicine, University La Sapienza, Rome, Italy. maurizio.muscaritoli@uniroma1.it
Molfino
Alessio
A
Chiappini
Maria Grazia
MG
Laviano
Alessandro
A
Ammann
Thomas
T
Spinsanti
Paola
P
Melchiorri
Daniela
D
Inui
Akio
A
Alegiani
Filippo
F
Rossi Fanelli
Filippo
F
D000368:Aged; D000855:Anorexia / Q000097:blood* / Q000209:etiology; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D005260:Female; D054439:Ghrelin; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000150:complications / Q000628:therapy; D008297:Male; D008875:Middle Aged; D036361:Peptide Hormones / Q000097:blood*; D006435:Renal Dialysis / Q000009:adverse effects*
D054439:Ghrelin; D036361:Peptide Hormones; C422650:ghrelin, des-n-octanoyl