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Changes in body composition of children with chronic renal failure on growth hormone
V L Johnson1, J Wang, F J Kaskel
1Department of Pediatrics, Weill Medical Collee of Cornell University, New York, NY 10021, USA. vljohns@med.cornell.edu
Insights
Recombinant human growth hormone (rhGH) therapy improved height and weight in children with chronic renal failure (CRF). Growth occurred with reduced body fat and increased fat-free mass, but not improved bone mineral density or BMI.
Area of Science:
- Pediatric Nephrology
- Endocrinology
- Metabolic Bone Disease
Background:
- Children with chronic renal failure (CRF) experience significant growth failure due to altered body composition.
- Recombinant human growth hormone (rhGH) is a potential therapeutic agent for improving somatic growth in pediatric CRF patients.
Purpose of the Study:
- To investigate the effects of rhGH therapy on body composition in children with chronic renal insufficiency and end-stage renal disease.
- To determine if growth achieved with rhGH correlates with changes in body composition.
Main Methods:
- Seven prepubertal and pubertal children with CRF received subcutaneous rhGH (0.35 mg/kg/week) for 6 months.
- Body composition was assessed using dual-energy X-ray absorptiometry (DXA), total body potassium counting, and deuterated water dilution.
- Measurements included total body fat (FM), fat-free mass (FFM), bone mineral density (BMD), total bone mineral mass (TBBM), total body water (TBW), and total body potassium (TBK).
Main Results:
- Significant increases in height and weight were observed after 6 months of rhGH therapy.
- rhGH treatment led to significant reductions in FM and percentage fat.
- Significant increases were noted in FFM, TBBM, and TBK (body cell mass), while total BMD remained unchanged.
- Body mass index (BMI) did not change significantly despite improvements in body composition.
Conclusions:
- rhGH therapy promotes growth in children with CRF by improving FFM and TBBM.
- Body composition changes, including fat reduction and FFM increase, accompany rhGH-induced growth in pediatric CRF.
- BMI alone is insufficient to assess the complex body composition changes occurring during rhGH treatment in CRF patients.
Abstract:
Body composition is altered in children with chronic renal failure (CRF) and contributes to the significant growth failure seen in these children. Recombinant human growth hormone (rhGH) has been used in the past several years to improve the somatic growth of children with CRF. To determine if the growth achieved in these children occurs concomitantly with body compositional changes, seven prepubertal (n=6) and pubertal (n=1) children with chronic renal insufficiency (n=4) and end-stage renal disease (n=3) underwent measurements of total body fat (FM), fat free mass (FFM), bone mineral density (BMD), total bone mineral mass (TBBM), total body water (TBW), and total body potassium (TBK) before and 6 months after initiation of subcutaneous recombinant human growth hormone (rhGH) at 0.35 mg/kg per week. The techniques used included dual-energy X-ray absorptiometry (for measurement of FM, BMD, and TBBM), total body potassium counting (for measurement of TBK), and deuterated water for assessment of TBW. Significant increases in both height and weight were seen following 6 months of rhGH therapy. These increases were accompanied by significant reductions in FM (4.4+/-1.4 kg vs. 3.6+/-1.2 kg, P=0.002) and percentage fat (18.6+/-3.9% vs. 14.5+/-3.4%, P=0.04), while FFM (17.9+/-3.0 kg vs. 20.7+/-3.6 kg, P=0.04) increased significantly as did TBBM (776+/-171 g vs. 844+/-177 g, P=0.001). Increases in TBK, a measure of body cell mass, were also seen. No difference in total BMD was observed. Thus, growth in CRF is occurring with repletion of the FFM and TBBM compartments. Despite these improvements, no change was observed in the body mass index (BMI). Measurement of BMI alone does not define the compartmental catabolic losses in FFM.