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Accelerated growth in short children with chronic renal failure treated with both strict dietary therapy and
M J van Renen1, R J Hogg, A L Sweeney
1Department of Nephrology, Adelaide Children's Hospital, South Australia.
Insights
Recombinant human growth hormone (rhGH) therapy combined with a specialized diet significantly improved growth in boys with chronic renal failure. This treatment enhanced height velocity and standard deviation scores without negatively impacting renal function.
Area of Science:
- Pediatric Nephrology
- Endocrinology
- Growth Disorders
Background:
- Children with chronic renal failure often experience significant growth failure.
- Conventional treatments have limited success in improving growth in these patients.
- Dietary management, including keto and amino acid supplementation, has shown some promise.
Purpose of the Study:
- To evaluate the efficacy of recombinant human growth hormone (rhGH) in conjunction with a specialized diet for improving growth in prepubertal and pubertal boys with chronic renal failure.
- To assess the impact of this combined therapy on growth velocity, height standard deviation scores (SDS), renal function, and bone age progression.
Main Methods:
- A 12-month prospective study involving nine boys (aged 4.8-15.6 years) with moderate to severe chronic renal failure and growth failure.
- Participants were on a strict low-protein/low-phosphate diet supplemented with keto/amino acids and energy for at least two years prior to rhGH initiation.
- Daily rhGH administration was initiated, and growth parameters, renal function, and bone age were monitored.
Main Results:
- Mean height velocity significantly increased in both prepubertal (4.6 to 9.0 cm/year) and pubertal (5.4 to 10.4 cm/year) groups (P < 0.001 and P < 0.01, respectively).
- Mean height SDS for chronological age improved in both prepubertal (-2.2 to -1.5) and pubertal (-1.9 to -1.3) groups (P < 0.01 and P < 0.02, respectively).
- No significant deterioration in renal function or bone disease was observed, and bone age advancement was consistent with chronological age.
Conclusions:
- Combined therapy of rhGH and a specialized renal diet is effective in improving growth in children with chronic renal failure.
- This therapeutic approach offers a significant benefit for growth failure associated with chronic kidney disease without compromising renal health.
- Further research may explore long-term outcomes and optimal therapeutic strategies.
Abstract:
In a 12-month study, nine boys, aged 4.8-15.6 years, with bone ages 4.6-13 years, with moderate to severe chronic renal failure and resultant growth failure were treated with daily recombinant human growth hormone (rhGH), in conjunction with a strict low-protein/low-phosphate diet supplemented with keto and amino forms of the essential amino acids, histidine and additional energy. Improved growth had previously been observed with this dietary management over that obtained with conventional treatment for chronic renal failure. Each child had been on this diet for at least 2 years before rhGH was commenced. Mean height velocity increased from 4.6 +/- 1.3 to 9.0 +/- 1.3 cm/year (P < 0.001) in the pre-pubertal group, and in the pubertal group from 5.4 +/- 1.4 to 10.4 +/- 1.8 cm/year (P < 0.01). The mean height velocity standard deviation scores (SDSs) increased from -1.2 +/- 0.6 to +2.3 +/- 0.9 (P < 0.001) in the pre-pubertal group and from -0.4 +/- 0.6 to +1.9 +/- 1.1 (P < 0.01) in the pubertal group. Mean height SDS for chronological age increased from -2.2 +/- 0.7 to -1.5 +/- 0.5 (P < 0.01) in the pre-pubertal group and from -1.9 +/- 0.7 to -1.3 +/- 0.9 in the pubertal group (P < 0.02). There was no significant deterioration in renal function or renal bone disease, and bone age did not advance more than chronological age over the 12-month period.