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Subcutaneous Ghrelin Enhances Acute Food Intake in Malnourished Patients Who Receive Maintenance Peritoneal Dialysis: A Randomized, Placebo-Controlled Trial

Katie Wynne^*, Kalli Giannitsopoulou^*, Caroline J. Small^*, Michael Patterson^*, Gary Frost^*, Mohammad A. Ghatei^*, Edwina A. Brown, Stephen R. Bloom^* and Peter Choi

^* Department of Metabolic Medicine, Faculty of Medicine, Imperial College London, Hammersmith Hospital; and Directorate of Renal and Transplant Medicine, Hammersmith Hospitals NHS Trust, Charing Cross Hospital, London, United Kingdom

Address correspondence to: Dr. Peter Choi, Renal Services, Ground Floor Pilot Wing, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK. Phone: +44-208-846-1754; Fax: +44-208-846-7589; E-mail: p.choi{at}imperial.ac.uk

Received for publication January 11, 2005. Accepted for publication March 29, 2005.

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.

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