Aguilera A, Codoceo R, Selgas R, Picronell M, Garcia P, Diaz
C, Sanchez C, Bajo MA
Orexigen and anorexigen plasma levels in peritoneal dialysis
patients. Their relationship with nutritional parameters.
17th Annual CAPD Conference
Perit Dial Int Suppl 1
(Feb) 17:S11 1997
Why patients on dialysis don't eat is not entirely clear, and the reasons
are undoubtedly multifactorial. In CAPD the role of dialysate causing
diminished appetite has been mentioned. See also the abstract by Fernstrom et al at this meeting, pointing
toward delayed gastric emptying in CAPD patients. However, in this paper
Aguilera et al focus on accumulation of possibly anorexigenic substances in
CAPD patients, such as TNF-alpha and cholecystokinin (CCK), as well as
plasma levels of neuropeptide Y (NPY), which may have an appetite promoting
effect. TNF-alpha and CCK levels were high in most patients, and NPY
levels tended to be normal. There seemed to be some relation to anorexia,
in that in 16/42 patients with anorexia, TNF-alpha levels were higher (mean
76 pg/ml) than in patients without GI symptoms (mean 52). Such a relation
was not found re: plasma CCK levels.
Comment: The authors conclude that high TNF-alpha levels,
especially, may be causal in anorexia in CAPD patients. The data
supporting this contention are scant, however. There is a plethora of
mediators that is increased in ESRD patients, and the difference in plasma
TNF-alpha levels between the anorectic and non-anorectic groups was not
impressive. (John T. Daugirdas, M.D., University of Illinois at
Chicago)
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17th Annual CAPD Conference
CRF by organ system :
Nutrition