such as the melanocortin-4 receptor.56,57 Chronic renal
failure mice knockout for this receptor ate normally, whereas
their wild-type melanocortin-4 receptor counterparts severely
reduced their food intake as a response to kidney
failure.56 When a melanocortin-4 receptor antagonist (such
as NBI-12i) was administered to uremic mice, they gained
lean and fat mass while lowering their energy expenditure,
resulting in a net nutritional improvement. These findings
may represent an interesting field to explore in order to
improve patients appetite and food intake.
Growth hormone has also been associated with improved
food efficiency in CKD. Indeed, Mehls et al.58 reported that
uremic rats receiving recombinant growth hormone gained
more weight per gram food intake than uremic rats receiving
vehicle. Combining growth hormone and insulin-like growth
factor-1 improved food utilization and anabolic response in
experimental59 and clinical CKD.60
Muscle wasting is a predominant feature of CKD and is
particularly present in long-term maintenance dialysis
patients. Low muscle mass is associated with increased
mortality.61 Muscle wasting results partly from reduced
physical activity (see section below) but also because of
resistance to anabolic factors. The impaired action of growth
hormone and/or insulin-like growth factor-1 has been
studied in detail during maintenance dialysis in children
and adults as well.62–64 Short-term therapeutic interventions
have been successful in improving body composition,65,66
however side effects request long-term studies that are not yet
such as the melanocortin-4 receptor.56,57 Chronic renalfailure mice knockout for this receptor ate normally, whereastheir wild-type melanocortin-4 receptor counterparts severelyreduced their food intake as a response to kidneyfailure.56 When a melanocortin-4 receptor antagonist (suchas NBI-12i) was administered to uremic mice, they gainedlean and fat mass while lowering their energy expenditure,resulting in a net nutritional improvement. These findingsmay represent an interesting field to explore in order toimprove patients appetite and food intake.Growth hormone has also been associated with improvedfood efficiency in CKD. Indeed, Mehls et al.58 reported thaturemic rats receiving recombinant growth hormone gainedmore weight per gram food intake than uremic rats receivingvehicle. Combining growth hormone and insulin-like growthfactor-1 improved food utilization and anabolic response inexperimental59 and clinical CKD.60Muscle wasting is a predominant feature of CKD and isparticularly present in long-term maintenance dialysispatients. Low muscle mass is associated with increasedmortality.61 Muscle wasting results partly from reducedphysical activity (see section below) but also because ofresistance to anabolic factors. The impaired action of growthhormone and/or insulin-like growth factor-1 has beenstudied in detail during maintenance dialysis in childrenand adults as well.62–64 Short-term therapeutic interventionshave been successful in improving body composition,65,66however side effects request long-term studies that are not yet
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