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Peritoneal loss of growth hormone in children on automated peritoneal dialysis
D Haffner1, C Hofstetter, O Mehls
1Pediatric Nephrology Division, University Children's Hospital, Heidelberg, Germany.
Insights
Children on peritoneal dialysis (PD) lose minimal amounts of growth hormone (GH) daily, with losses being less than 0.1% of the recombinant human GH (rhGH) dose. This study quantifies GH loss during PD, finding it doesn't explain treatment response variability.
Area of Science:
- Pediatric Nephrology
- Endocrinology
- Dialysis Research
Background:
- Growth hormone (GH) is crucial for pediatric development.
- Children with end-stage renal disease often require renal replacement therapy, such as peritoneal dialysis (PD).
- Recombinant human GH (rhGH) therapy is used to address growth issues in these children, but its efficacy can vary.
Purpose of the Study:
- To quantify the daily loss of GH in children undergoing automated peritoneal dialysis (APD).
- To determine if dialytic GH loss contributes to the variability in rhGH treatment response.
- To explore the potential of monitoring GH elimination for assessing rhGH treatment compliance and plasma concentrations.
Main Methods:
- A prospective study was conducted on 26 children undergoing APD.
- Dialysate was collected over 3 consecutive days to measure GH, alpha1-microglobulin, beta2-microglobulin, transferrin, and albumin losses.
- Patients were categorized into those receiving daily rhGH (n=6) and those not (n=20).
Main Results:
- Mean daily dialytic GH loss was 2.18 µg/1.73 m²/day in rhGH-treated patients and 0.42 µg/1.73 m²/day in untreated patients (p < 0.05).
- GH loss showed positive correlations with beta2-microglobulin (r=0.77) and alpha1-microglobulin (r=0.51) losses.
- Less than 0.1% of the injected rhGH dose was eliminated via dialysis, and daily peritoneal GH loss was minimal relative to endogenous production.
Conclusions:
- Peritoneal GH losses in children on APD represent a minor fraction of metabolic clearance and do not explain treatment response variability.
- Monitoring dialytic GH elimination can potentially estimate mean plasma GH concentrations.
- Assessment of dialytic GH elimination may serve as a tool for monitoring rhGH treatment compliance in pediatric PD patients.
Objective:
To provide quantitative data regarding the daily dialytic loss of growth hormone (GH) in children on peritoneal dialysis (PD).
Design:
Prospective study involving 24-hour dialysate collections on 3 consecutive days in patients with and without recombinant human GH (rhGH) treatment.
Setting:
Single-center outpatient PD program.
Patients:
Twenty-six children undergoing automated PD (APD): 6 with and 20 without daily rhGH.
Main Outcome Measures:
Daily peritoneal losses of GH, alpha1-, beta2-microglobulin, transferrin, and albumin.
Results:
The mean (+/-SEM) daily dialytic GH loss was 2.18+/-0.62 microg/1.73 m2 per day in rhGH-treated patients and 0.42+/-0.28 microg/1.73 m2 per day in untreated patients, (p < 0.05). The intraindividual coefficient of variation of daily GH loss was 65%. The peritoneal loss of GH was positively correlated with that of beta2-microglobulin (r = 0.77, p < 0.001) and alpha1-microglobulin (r = 0.51, p < 0.01). The variability in beta2-microglobulin and alpha1-microglobulin elimination, together with the use of rhGH, explained 66% of the total variability of daily GH excretion. In patients without rhGH therapy, the daily peritoneal GH loss was approximately 0.05% of the estimated daily endogenous production rate based on previous estimates in children with end-stage renal failure. In patients on rhGH therapy, less than 0.1% of the injected rhGH dose was eliminated by dialysis.
Conclusion:
Peritoneal losses of GH in children on APD account only for a minute fraction of endogenous metabolic clearance, and do not explain the variability of the rhGH treatment response. The assessment of dialytic GH elimination may be used to estimate time-integrated mean plasma GH concentrations, and to monitor rhGH treatment compliance.