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Published on: January 7, 2016
Use of recombinant human growth hormone in children with chronic renal insufficiency: an update
Insights
Recombinant human growth hormone (rhGH) therapy significantly improves growth velocity in children with chronic renal failure (CRF). This treatment facilitates catch-up growth, addressing stunted growth common in pediatric CRF patients.
Area of Science:
- Pediatric Nephrology
- Endocrinology
- Growth Hormone Therapy
Background:
- Chronic renal insufficiency (CRI) frequently causes growth retardation in children.
- Advancements in dialysis and transplantation highlight the need to address persistent short stature.
- Recombinant human growth hormone (rhGH) is explored for growth enhancement in pediatric patients with chronic kidney disease (CKD).
Purpose of the Study:
- To evaluate the efficacy of rhGH in promoting growth in children with chronic renal failure (CRF) before dialysis.
- To assess changes in growth velocity (GV) and height standard deviation scores (SDS) during rhGH treatment.
- To monitor for adverse effects and changes in renal function during rhGH therapy.
Main Methods:
- Eleven male patients with CRF (ages 2.5-16.3 years) and height SDS > -2.0 were treated with rhGH.
- Initial dosing: 0.125 mg/kg three times weekly; later changed to 0.053 mg/kg/day.
- Treatment duration ranged from 18 to 48 months, with growth assessed at 12, 24, 36, and 48 months.
Main Results:
- Mean growth velocity (GV) increased significantly from baseline (5.4 cm/year) to 8.9 cm/year at 12 months.
- Mean height SDS improved from > -3.0 to < -1.5, with one patient reaching the 50th percentile.
- No significant adverse effects or changes in creatinine clearance were observed; two patients initiated dialysis as expected for their condition.
Conclusions:
- rhGH therapy effectively increases growth velocity in children with CRF.
- rhGH facilitates catch-up growth, improving height deficits in this patient population.
- The treatment appears safe and well-tolerated in children with CRF prior to dialysis.
Abstract:
Growth retardation is common in children with chronic renal insufficiency (CRI). Now that dialysis and renal transplantation (TX) have become life sustaining, permanent stunted growth and adult short stature often occurs. Thus, efforts to enhance growth using recombinant human growth hormone (rhGH) have been undertaken in three groups of patients: chronic renal failure (CRF) prior to dialysis; end-stage renal disease (ESRD) on some form of dialysis; and following TX (post-TX) in whom growth retardation persists. Our initial study was in CRF. Eleven males, ages 2.5-16.3 years, with height standard deviation scores (SDS) of > 2.0 below the mean, have been treated with rhGH for 18-48 months. rhGH was started in a dose of 0.125 mg/kg three times a week in the first 8 patients and subsequently changed to daily dosing (0.053 mg/kg/day) within the first 24 months. To date, overall, growth velocity (GV) increased from 5.4 +/- 2.2 to 8.9 +/- 1.6, 7.5 +/- 1.8, 7.5 +/- 1.6 and 6.9 +/- 0.9 cm/year in those completing 12 (n = 11), 24 (n = 9), 36 (n = 7), and 48 (n = 3) months. The mean height SDS increased from > 3.0 to < 1.5 below the mean with 1 patient reaching the 50th centile. Dialysis was initiated in 2 patients, a frequency not different from that expected over time in children with this degree of CRF. In the others, calculated creatinine clearance did not change, and no significant adverse effects were noted as a consequence of the rhGH treatment. Thus, rhGH increases GV and facilitates catch-up growth in CRF.(ABSTRACT TRUNCATED AT 250 WORDS)
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