This subproject is one of many research subprojects utilizing theresources provided by a Center grant funded by NIH/NCRR. The subproject andinvestigator (PI) may have received primary funding from another NIH source,and thus could be represented in other CRISP entries. The institution listed isfor the Center, which is not necessarily the institution for the investigator.Patients with chronic renal failure (CRF) are prone to develop malnutrition which is associated with increased morbidity and mortality. Malnutrition could result from either impaired eating or excessive catabolism. We will assess appetite, measure food consumption and at the same time quantitate catabolism by measuring metabolic rate and urinary urea nitrogen excretion. Simultaneously, we will measure a number of hormones known to be related to eating and energy expenditure. The perturbation to be introduced in this study will include 40 hours of fasting and 24 hours of re-feeding. Four groups of study subjects will be included (1) CRF patients on hemodialysis, (2) CRF patients not yet on dialysis, (3) renal transplant subjects and (4) normal controls. The hormones to be studied are divided into two categories, those that have a circadian rhythm and those that are meal-related. The former includes leptin, neuropeptide Y and alpha melanocyte-stimulating hormone, and the latter, cholecystokinin, ghrelin and peptide YY. All the measurements will be done in baseline state, during a 40-hour fast and a 24-hour re-feeding. Overall nutritional status of the subjects will be assessed using DEXA scan, anthropometry and subjective global assessment score. Appetite will be assessed by the visual analogue scale.
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