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rhGH use in children with CRI and undergoing dialysis post-transplant in Japan: a multicentre study. MultiCenter
1Department of Pediatric Nephrology, Tokyo Women's Medical College, Japan.
Insights
Recombinant human growth hormone (rhGH) effectively boosts growth velocity in children with chronic renal insufficiency (CRI), including those on dialysis. Higher rhGH doses may increase risks of acute rejection in transplanted children.
Area of Science:
- Pediatric Endocrinology
- Nephrology
- Growth Hormone Therapy
Background:
- Children with chronic renal insufficiency (CRI) often experience growth impairment.
- Growth hormone (GH) therapy is a potential treatment for growth failure in these children.
Purpose of the Study:
- To evaluate the efficacy and safety of recombinant human growth hormone (rhGH) in improving growth velocity (GV) in children with CRI, including those on dialysis and post-transplant.
- To compare the effects of two different rhGH dosages (0.5 and 1.0 i.u./kg/week).
Main Methods:
- A one-year study involving 83 children with CRI (pre-dialysis and dialysis) and 23 transplanted children.
- rhGH was administered at doses of 0.5 or 1.0 i.u./kg/week.
- Growth velocity was measured at baseline, six months, and one year.
Main Results:
- rhGH significantly increased GV in pre-dialysis and dialysis-dependent children at both dosages.
- The 1.0 i.u. dose showed a greater increase in GV compared to the 0.5 i.u. dose in these groups.
- Transplanted children also showed improved GV, but no significant difference was found between the two rhGH doses.
- A higher incidence of acute rejection (AR) was observed in transplanted children treated with the 1.0 i.u. dose (38%) compared to the 0.5 i.u. dose (20%).
Conclusions:
- rhGH is effective in stimulating GV in children with CRI, including those on dialysis.
- While effective, rhGH treatment in transplanted children requires careful monitoring due to a potential increased risk of acute rejection, particularly at higher doses.
- Further attention is needed regarding the impact of rhGH on renal function and graft stability.
Abstract:
We evaluated the effect of rhGH at both 0.5 and 1.0 i.u./kg/week, on the growth of 83 CRI (pre- and dialysis) and 23 transplanted children after one year. Growth velocity (GV) was significantly increased in predialysis children on a dose of 0.5 i.u. (p < 0.001), from 3.8cm/year at baseline to 7.8cm/year at six months and 7.3cm/year at one year. On a dose of 1.0 i.u., GV was increased from 4.5cm/year at baseline to 10.3cm/year at six months and 8.7cm/year at one year (p < 0.01). When the increment in GV was compared a significant difference was noted between 0.5 i.u. and 0.1 i.u. at both six and 12 months (p < 0.01). GV was also significantly increased in dialysed children treated with 0.5 i.u., from 3.5cm/year to 5.6cm/year at six months (p < 0.01) and 5.4cm/year at one year (p < 0.01). On a dose of 1.0 i.u., the increase was from 3.4 to 8.4cm/year at six months (p < 0.001) and 8.3cm/year at one year (p < 0.01). There was a significant difference in GV between the 0.5 and 1.0 i.u. groups at both six and 12 months (p < 0.01). In transplanted children, GV was significantly improved over one year of GH treatment from 5.0 to 7.7cm/year at 0.5 i.u. (p < 0.05) and from 3.7 to 6.3cm/year at 1.0 i.u. (p < 0.05); however, there was no statistical difference between the groups. Seven out of 23 children showed evidence of deterioration of graft function during rhGH treatment. This was due to acute rejection (AR) in every case. AR was noted in two of 10 children (20%) in the 0.5 i.u. group and five of 13 children (38%) in the 1.0 i.u. group. Our results demonstrate that rhGH effectively stimulates GV, not only in CRI, but also in dialysed children. Attention should, however, be paid to deterioration of renal function.