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Vitamin D metabolite requirements in dialysed children receiving recombinant human growth hormone
M Pańczyk-Tomaszewska1, H Ziółkowska, A Debiński
1Department of Paediatrics and Nephrology, Warsaw University Medical School, Warsaw, Poland.
Insights
Children undergoing recombinant human growth hormone (rhGH) therapy need higher active vitamin D doses. Frequent monitoring of parathyroid hormone (PTH) levels is crucial during rhGH treatment for optimal management.
Area of Science:
- Pediatric Nephrology
- Endocrinology
- Bone Metabolism
Background:
- Children with end-stage renal failure (ESRF) often have altered mineral metabolism.
- Recombinant human growth hormone (rhGH) therapy is used in children with ESRF.
- The impact of rhGH on vitamin D requirements in these patients is not fully understood.
Purpose of the Study:
- To evaluate the necessity of active vitamin D supplementation in children with ESRF during rhGH treatment.
- To assess the relationship between rhGH therapy and mineral metabolism markers.
Main Methods:
- A 6-month study involving 26 children (5-15 years) treated with rhGH.
- Two groups were analyzed: Group I received a fixed alfacalcidol dose, while Group II received alfacalcidol adjusted monthly based on parathyroid hormone (PTH) levels.
- Serum PTH, alkaline phosphatase (AP), calcium, and phosphorus levels were monitored.
Main Results:
- In Group I, PTH levels significantly increased after 3 and 6 months of rhGH treatment (P<0.05).
- AP activity increased in both groups, with a significant rise after 6 months in Group I (P<0.01).
- Calcium levels decreased in Group I, while phosphorus levels decreased in Group II (P<0.01). Group II required a 60.9% increase in alfacalcidol dosage.
Conclusions:
- Children with ESRF undergoing rhGH treatment require higher doses of active vitamin D.
- Close monitoring of serum PTH levels is essential during rhGH therapy in this population.
Background:
The aim of the study was to assess the requirement of active vitamin D in dialysed children during treatment with recombinant human growth hormone (rhGH).
Methods:
Twenty-six children (aged 5-15 years) were treated with rhGH for 6 months. The serum concentration of parathyroid hormone (PTH), alkaline phosphatase (AP), and calcium and phosphorus were measured in two groups of patients studied in the years 1994-1995 (group I) and 1995-1998 (group II) respectively. Group I received a constant dose of alfacalcidol that was sufficient to keep PTH below 200 pg/ml before rhGH treatment began. The serum PTH level was checked every 3 months. Alfacalcidol was administered to group II according to serum PTH levels checked on a monthly basis.
Results:
In group I the PTH level increased after 3 and 6 months of rhGH treatment from mean level 73+/-60; 155+/-156 and 344+/-249 pg/ml respectively; P<0.05. AP activity increased after 6 months of treatment from 206+/-99 to 325+/-124 U/l respectively; P<0.01. The calcium level decreased from baseline after 3 months of treatment from 2.36+/-0.21 to 2.17+/-0.12 mmol/l respectively; P<0.05. In group II AP activity increased after 3 and 6 months of treatment from 272+/-169 to 332+/-192 and 404. 9+/-219.8 U/l respectively; P<0.01. The mean level of phosphorus decreased after 6 months from 2.15+/-0.28 to 1.70+/-0.39 mmol/l respectively; P<0.01. In group II the mean dose of alfacalcidol increased by 60.9%.
Conclusions:
In children with end-stage renal failure, higher doses of vitamin D are needed during rhGH treatment. During rhGH treatment, frequent control of serum PTH level is necessary.