Chronic kidney disease (CKD) is associated with an increase in inflammatory cytokines and can result in cachexia with loss of muscle and fat stores. We previously demonstrated the efficacy of treating a model of cancer cachexia with ghrelin and a ghrelin receptor agonist. Currently, we examine a surgical model of CKD in rats, resulting in uremia and decreased accrual of lean body mass. Treatment with ghrelin and two ghrelin receptor agonists (BIM-28125 and BIM-28131) resulted in increased food intake and an improvement in lean body mass accrual that was related in part to a decrease in muscle protein degradation as assessed by muscle levels of the 14-kDa actin fragment resulting from cleaved actomyosin. Additionally, there was a decrease in circulating inflammatory cytokines in nephrectomized animals treated with ghrelin relative to saline treatment. Ghrelin-treated animals also had a decrease in the expression of IL-1 receptor in the brainstem and a decrease in expression of prohormone convertase-2, an enzyme involved in the processing of proopiomelanocortin to the anorexigenic peptide âŁ-MSH. We conclude that ghrelin treatment in uremia results in improved lean mass accrual in part due to suppressed muscle proteolysis and possibly related to antiinflammatory effects. (Endocrinology 149: 827-835, 2008) P ATIENTS WITH CHRONIC kidney disease (CKD) often exhibit symptoms of anorexia, loss of lean body mass, and increased energy expenditure, matching the syndrome of cachexia seen in other chronic diseases such as cancer, chronic heart failure, and AIDS (1, 2). In addition, patients with CKD-induced uremia frequently exhibit a dangerous decrease in protein nutritional status, including decreased levels of albumin and prealbumin as well as catabolism of actinomycin in muscle tissue via caspase-3 and the ubiquitinproteasome pathway (3-8). As with other diseases associated with cachexia, these catabolic processes seen in CKD are linked to systemic inflammatory changes, including increases in acute-phase reactants such as C-reactive protein and inflammatory cytokines (9 -15). Indeed, this inflammation is felt to be in the causative pathway of the production of cachexia (16 -19).CKD is similar to other diseases associated with cachexia in that the symptoms of cachexia in CKD are associated with a decrease in quality of life and an increase in mortality (20 -26). Unfortunately, no single agent has emerged as a beneficial treatment for cachexia (27). One potential treatment for cachexia in multiple disease states is the use of the orexigenic hormone ghrelin (28, 29). Although ghrelin levels are already elevated above normal in cachexia-associated disease states such as cancer, heart failure, and CKD, administration of supraphysiological doses of ghrelin has been shown to increase food intake in human subjects with cancer and heart failure (30 -34).We have previously delivered ghrelin and ghrelin agonists in a rat model of cancer cachexia, demonstrating improved lean body mass retention and increases in gene expression of ag...