Protein-energy wasting and ghrelin in children sufferingfrom chronic kidney disease

Ghrelin stimulates appetite, increases food consumption and encourages fat storage. In children with chronic illnesses,malnutrition is common, so it is essential to examine how to prevent malnutrition. The purpose of this study is toassess plasma concentrations of ghrelin in children with chronic kidney disease (CKD) and to assess their role inprotein energy loss (PWE).Material and MethodsTo accomplish this narrative review, we searched ۴ Databases (PubMed, Web of Science, Scopus and google scholar)based on the search strategy from ۲۰۱۰ to ۲۰۲۲ with the high sensitivity on September ۲۰۲۲ by following MeSHkeywords: " Ghrelin ", " Protein-energy wasting ", " chronic kidney disease “, " Children ".FindingsGhrelin regulates fat distribution and energy metabolism in lean tissues, including the liver and muscles. In muscles,ghrelin increased mitochondrial oxidative enzyme activities independent of changes in fat metabolism genes andphosphorylated AMPK. Expression of peroxisome proliferator-activated receptor-γ (PPAR-γ), the activation of whichreduces muscle fat content, was selectively increased in muscle where it paralleled changes in oxidative capacities.Thus, ghrelin induces tissue-specific changes in mitochondrial and lipid metabolism gene expression and favorstriglyceride deposition in the liver over skeletal muscle. Patients with PEW and low ghrelin values had abnormallyhigh C-reactive protein and leptin by multivariate analysis of variance and the highest mortality risk compared to non-PEW with high ghrelin from all-cause cardiovascular-related mortality.Conclusion Ghrelin appears to be a promising tool for modulating appetite and muscular metabolism with the potential tocounteract the loss of lean body mass in CKD.

Keywords:

Ghrelin , Protein-energy wasting , Chronic kidney disease , Children