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Ghrelin in Health and Disease pp 231–256Cite as

Ghrelin in Cachexia Associated with End-Stage Renal Disease

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Part of the book series: Contemporary Endocrinology ((COE,volume 10))

Abstract

Much of the high mortality seen in chronic renal failure is due to a form of vascular disease which, unlike the overnutrition vascular disease of the general population, is closely associated with the development of malnutrition. Various micronutrient deficiencies occur, and are commonly treatment related, but a specific syndrome of energy malnutrition associated with unexplained activation of inflammatory mediators, is a common and early feature of renal failure, which is frequently refractory to nutritional supplementation. Many abnormalities of appetite hormones have been found in renal failure, and like obesity, renal malnutrition is increasingly understood as a disorder of appetite homeostasis, which therefore would respond best to manipulation of the appetite regulatory system—for example by administration of ghrelin. Reduced clearance by failing kidneys leads to accumulation of ghrelin, with elevated circulating levels of total ghrelin; however, a reduction in the acyl fraction has been found. Acyl ghrelin administration has been shown to increase energy intake in animal models of renal failure, and promising results have also been found with daily subcutaneous injections in dialysis patients over the course of a week. In addition, ghrelin is thought to have an anti-inflammatory effect, which may be therapeutically relevant in a syndrome in which inappropriate inflammation is a prominent feature.

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Authors and Affiliations

  1. Hammersmith Hospital, Imperial College Kidney and Transplant Institute, Du Cane Road, London, W12 0HS, UK

    Damien Ashby M.R.C.P., Ph.D.

  2. Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK

    Peter Choi M.A., M.B., B.Chir., Ph.D., F.R.C.P.

  3. Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK

    Stephen Bloom M.D., D.Sc., F.Med.Sci.

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  1. Damien Ashby M.R.C.P., Ph.D.
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  2. Peter Choi M.A., M.B., B.Chir., Ph.D., F.R.C.P.
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  3. Stephen Bloom M.D., D.Sc., F.Med.Sci.
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Correspondence to Damien Ashby M.R.C.P., Ph.D. .

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  1. , Department of Metabolism and Aging, The Scripps Research Institute Florida, Scripps Way 3B3 130, Jupiter, 33458, Florida, USA

    Roy G. Smith

  2. , Department of Medicine, University of Virginia, Ray C Hunt Drive 450, Charlottesville, 22908, Virginia, USA

    Michael O. Thorner

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Ashby, D., Choi, P., Bloom, S. (2012). Ghrelin in Cachexia Associated with End-Stage Renal Disease. In: Smith, R., Thorner, M. (eds) Ghrelin in Health and Disease. Contemporary Endocrinology, vol 10. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-61779-903-7_13

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