Peritoneal loss of growth hormone in children on automated peritoneal dialysis

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.