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Long-term experience with growth hormone treatment in children with chronic renal failure
F Schaefer1, D Haffner, E Wühl
1Division of Pediatric Nephrology, University Children's Hospital, Heidelberg, Germany.
Insights
Recombinant human growth hormone (rhGH) effectively promotes growth in children with chronic renal failure (CRF), leading to sustained height percentile growth. Early treatment is recommended to maximize benefits before potential catch-down growth upon discontinuation.
Area of Science:
- Pediatrics
- Nephrology
- Endocrinology
Background:
- Chronic renal failure (CRF) significantly impairs growth in children.
- Recombinant human growth hormone (rhGH) has been used for over a decade in this population.
- Long-term data on rhGH efficacy and safety in pediatric CRF is crucial.
Purpose of the Study:
- To evaluate the long-term efficacy and safety of rhGH in children with CRF.
- To identify factors influencing rhGH treatment outcomes.
- To establish optimal treatment timing and duration.
Main Methods:
- Analysis of a decade of clinical experience with rhGH treatment in prepubertal children with CRF.
- Assessment of growth parameters, skeletal maturation, and potential side effects.
- Correlation analysis of treatment efficacy with patient age, baseline height velocity, genetic factors, and renal function.
Main Results:
- rhGH achieves partial catch-up growth in the first three years, followed by sustained percentile-parallel growth.
- Discontinuation of rhGH leads to catch-down growth in 75% of patients.
- Efficacy is influenced by age, baseline height velocity, genetic target height, and residual renal function; skeletal maturation is not accelerated.
- Side effects include insulin secretion stimulation without glucose intolerance changes and rare benign intracranial hypertension.
Conclusions:
- rhGH has established long-term efficacy and safety, offering a new management strategy for growth failure in pediatric CRF.
- Early initiation of rhGH treatment in childhood and early renal failure stages is recommended.
- Treatment should continue until at least renal transplantation, with ongoing evaluation of adult height outcomes.
Abstract:
After a decade of experience with recombinant human growth hormone (rhGH) in children with chronic renal failure (CRF), the long-term efficacy and safety of the drug is now established. In prepubertal children, partial catch-up growth is achieved during the first three treatment years, followed by sustained percentile-parallel growth. Discontinuation of rhGH treatment results in catch-down growth in 75% of patients. Treatment efficacy is inversely correlated with age and baseline height velocity, and positively influenced by genetic target height and residual renal function. Skeletal maturation is not accelerated, suggesting a true increase in final height potential. Side effects are limited to a stimulation of insulin secretion, which is not associated with changes in glucose tolerance, and occasional cases of benign intracranial hypertension. In summary, the advent of rhGH has opened a new era in the management of growth failure in CRF. Available evidence suggests that treatment should start in early childhood and early in the course of renal failure, and should be continued at least until renal transplantation. It remains to be seen whether the beneficial effect of rhGH on height observed during the prepubertal period will result in an eventual increase in adult height.