GHRL and malnutrition: In fact, acylated ghrelin stimulates food intake and des-acyl form has anorexigenic effect.6 In those studies that measured the acylated moiety of ghrelin, elevation in both ghrelin and des-acyl and alteration of the acyl ghrelin/total ghrelin ratio were reported in the end stage of renal disease patients undergoing dialysis in comparison with controls, in pediatric and adults patients, respectively.6,15 Des-acyl ghrelin levels have been linked with malnutrition in human19,20 and elevated levels of des-acyl ghrelin may contribute to appetite decrease in uremic patients.