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This Article Full Text Full Text (PDF) All Versions of this Article: 288/1/E47    most recent 00163.2004v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (3) Citing Articles via Google Scholar Google Scholar Articles by Deshmukh, S. Articles by Lim, V. S. Search for Related Content PubMed PubMed Citation Articles by Deshmukh, S. Articles by Lim, V. S.

Hormonal responses to fasting and refeeding in chronic renal failure patients

¹Department of Medicine, College of Medicine, and ²College of Pharmacy, University of Iowa, Iowa City, Iowa

Submitted 8 April 2004 ; accepted in final form 5 August 2004

To study anorexia in chronic renal failure (CRF) patients, we measured appetite-related hormones in seven CRF patients and four controls. Plasma concentrations and fractional changes from baseline (values from day 1, 0800) are listed as control vs. CRF (means ± SE). Leptin, although higher in CRF (5.6 ± 1.7 and 34 ± 17 ng/ml), was suppressed after fasting; decrements were –51 ± 9 and –55 ± 8%. Nocturnal surge present during feeding was abolished upon fasting in both groups. Neuropeptide Y (NPY) was elevated in CRF (72 ± 12 vs. 304 ± 28 pg/ml, P = 0.0002). NPY rhythm, reciprocal to that of leptin, was muted in CRF. Basal cortisol was similar in both groups (17 ± 3 and 17 ± 2 µg/dl). In the controls, cortisol peaked in the morning and declined in the evening. CRF showed blunted cortisol suppression. Decrements were –61 ± 3 and –20 ± 9% at 1800 on day 1 (P = 0.008) and –61 ± 8 and –26 ± 8% at 2000 on day 2 (P = 0.02). Basal ACTH (25 ± 5 and 54 ± 16 pg/ml) as well as diurnal pattern was not statistically different between the groups. Baseline insulin was 6 ± 1 and 20 ± 9 µU/ml. During fasting, insulin was suppressed to –64 ± 10 and –51 ± 9%, respectively. Upon refeeding, increments were 277 ± 96 and 397 ± 75%. Thus, in our CRF patients, anorexia was not due to excess leptin or deficient NPY. Impaired cortisol suppression should favor eating. Insulin suppression during fasting and secretion after feeding should enhance both eating and anabolism. The constant high NPY suggests increased tonic hypersecretion.

hormones; appetite; uremia

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