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[Chronic kidney insufficiency: results of treatment with growth hormone]
1Afd. Kindergeneeskunde, Erasmus Universiteit en Academisch Ziekenhuis/Sophia Kinderziekenhuis, Rotterdam.
Insights
Growth hormone (GH) therapy significantly improves growth velocity in children with chronic renal insufficiency (CRI). Optimal dosing is crucial for sustained catch-up growth, with higher doses showing better long-term results.
Area of Science:
- Pediatric Nephrology
- Endocrinology
- Growth Disorders
Background:
- Children with chronic renal insufficiency (CRI) often experience stunted growth, a condition not consistently improved by dialysis or renal transplantation.
- The exact cause of growth retardation in CRI is unclear, though growth hormone (GH) and insulin-like growth factors (IGF) appear normal, suggesting a role for IGF-binding proteins.
Purpose of the Study:
- To evaluate the efficacy and safety of growth hormone (GH) therapy in improving growth velocity in children with chronic renal insufficiency (CRI).
- To determine optimal GH dosing and treatment duration for sustained catch-up growth in this population.
Main Methods:
- Analysis of data from 2-year studies involving GH therapy at doses of 28 IU/m2/week and 14 IU/m2/week in children with CRI.
- Assessment of growth velocity, renal function, adverse events, and bone maturation in treated children.
Main Results:
- GH therapy at 28 IU/m2/week led to significant increases in growth velocity over 2 years without adverse effects on renal function.
- A lower dose of 14 IU/m2/week was insufficient to maintain catch-up growth beyond 6 months in children over 4 years old.
- Bone maturation remained unaffected, indicating potential for improved final height.
Conclusions:
- GH therapy is an effective treatment for stunted growth in children with CRI, particularly when initiated after a year of significant growth retardation.
- Higher GH doses (28 IU/m2/week) are recommended for sustained catch-up growth.
- While preliminary results in post-transplant children are promising, further long-term studies are required.
Abstract:
Stunted growth is a serious problem for many children with chronic renal insufficiency (CRI). Dialysis does not improve growth velocity, while renal transplantation does not always result in better growth either. The pathogenesis of the growth retardation is unknown, but growth hormone (GH) secretion and plasma levels of insulin-like growth factors (IGF) I and -II appear to be normal. Elevated levels of IGF-binding proteins may be involved in the growth retardation. Several 2-year studies have shown that impressive increase in growth velocity can be achieved with GH therapy with 28 IU/m2/week, without significant changes in renal function or adverse events. A lower GH dose of 14IU/m2/week was not able to maintain catch-up growth for longer than 6 months in children older than 4 years. Bone maturation appears unaffected, suggesting improved final height. In children with CRI GH-treatment is best started following 1 year of marked growth retardation. Preliminary results of GH-treatment in children after renal transplantation seem promising, but long-term data are needed before definitive conclusions can be drawn.