[Somatotropic axis and molecular markers of mineral metabolism in children undergoing chronic peritoneal dialysis]

Area of Science:

• Pediatric Nephrology
• Endocrinology
• Bone Metabolism

Background:

• Growth failure is a significant complication in children with chronic kidney disease (CKD).
• Growth hormone (GH) resistance and bone mineral disorders are key contributors to growth retardation in pediatric CKD.
• Peritoneal dialysis (PD) is a common treatment modality for pediatric CKD, necessitating evaluation of its impact on growth and mineral metabolism.

Purpose of the Study:

• To characterize bone mineral metabolism and growth hormone biomarkers in children with CKD undergoing chronic PD.
• To assess the efficacy of recombinant human growth hormone (rhGH) treatment in improving height in these patients.

Main Methods:

• A 12-month longitudinal follow-up study was conducted on prepubertal children with CKD on PD.
• Demographic, anthropometric, and biochemical data were collected, including FGF23, Klotho, Vitamin D, IGF-1, IGFBP3, and GHBP.
• Exclusion criteria included specific conditions and treatments that could affect growth or mineral metabolism.

Main Results:

• Fifteen prepubertal children on PD were studied, with an initial height-for-age Z-score of -1.69 ± 1.03.
• Elevated FGF23 and reduced Klotho levels were observed compared to healthy children.
• Eight patients treated with rhGH showed a trend towards improved height, and positive correlations were found between Klotho and growth, and GHBP and growth velocity index.

Conclusions:

• Children with CKD on PD exhibit dysregulated bone metabolism with high FGF23 and low Klotho levels.
• While somatotropic axis markers were generally normal or elevated, rhGH treatment showed a tendency to improve height.
• GHBP may serve as a useful biomarker for growth velocity in children with CKD on PD.