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In addition, ghrelin, a stomach-derived hormone that is involved in appetite stimulation, increases renal IGF-1 levels and improves renal function in a mouse model of ischemia-reperfusion.91 Consequently, the effects of the treatment with a ghrelin receptor agonist has been studied in patients undergoing hemodialysis, being efficient in increasing serum IGF-1 levels after three months of treatment, suggesting that the ghrelin receptor activation should be useful to prevent PEW in these patients.92 IGF-1 and CKD-MBD GH induces increased tubular phosphate reabsorption and 1,25-dihydroxyvitamin D3 production, which should be at least partially induced by the subsequent renal IGF-1 production

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