title: Sustained appetite improvement in malnourished dialysis patients by daily ghrelin treatment.
abstract: Malnutrition is a common complication in patients on dialysis and is strongly associated with poor prognosis. Effective therapy could substantially improve morbidity and mortality, but neither enteral nor parenteral supplementation provide long-term benefit because of the strong appetite suppression seen in such patients. We performed a double-blinded randomized crossover study of a week-long treatment with daily subcutaneous ghrelin, a gut hormone that regulates hunger through the hypothalamus, in a group of 12 malnourished dialysis patients. Ghrelin administration increased ghrelin levels in circulation, modestly reduced blood pressure for up to 2 h, and immediately and significantly increased appetite, with an increase in energy intake noted at the first study meal. Persistence of this effect throughout the week was confirmed with food diaries and final study meals. Energy expenditure, measured with free-living pulse and motion monitors, was unchanged by ghrelin. Our study shows that daily treatment with ghrelin achieves a sustained positive change in energy balance in malnourished dialysis patients. Direct manipulation of appetite with ghrelin or its analogs represents an attractive and promising therapeutic strategy for this difficult clinical problem.
authors.affiliation: Department of Investigative Medicine, Imperial College London, London, UK. d.ashby@imperial.ac.uk
authors.forename: Damien R
authors.initials: DR
authors.lastname: Ashby
authors.forename: Heather E
authors.initials: HE
authors.lastname: Ford
authors.forename: Katie J
authors.initials: KJ
authors.lastname: Wynne
authors.forename: Alison M
authors.initials: AM
authors.lastname: Wren
authors.forename: Kevin G
authors.initials: KG
authors.lastname: Murphy
authors.forename: Mark
authors.initials: M
authors.lastname: Busbridge
authors.forename: Edwina A
authors.initials: EA
authors.lastname: Brown
authors.forename: David H
authors.initials: DH
authors.lastname: Taube
authors.forename: Mohammad A
authors.initials: MA
authors.lastname: Ghatei
authors.forename: Frederick W K
authors.initials: FW
authors.lastname: Tam
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Bloom
authors.forename: Peter
authors.initials: P
authors.lastname: Choi
mesh_terms: D000328:Adult; D000368:Aged; D001066:Appetite / Q000187:drug effects*; D018592:Cross-Over Studies; D004311:Double-Blind Method; D002149:Energy Intake / Q000187:drug effects; D004734:Energy Metabolism / Q000187:drug effects; D005260:Female; D054439:Ghrelin / Q000008:administration & dosage* / Q000097:blood / Q000627:therapeutic use; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D008297:Male; D044342:Malnutrition / Q000188:drug therapy* / Q000628:therapy; D008875:Middle Aged; D006435:Renal Dialysis; D055815:Young Adult
chemical_list: D054439:Ghrelin