Growth hormone (GH) improves growth in children with chronic renal failure. The response to GH may be affected by the degree of secondary hyperparathyroidism and concurrent treatment with vitamin D. Forty-six rats underwent 5/6 nephrectomy (Nx) and were given a high-phosphorus diet (Nx-Phos) to induce advanced secondary hyperparathyroidism and divided into the following groups: (1) Nx-Phos (n ؍ 10) received saline, (2) GH at 10 IU/kg per d (Nx-Phos؉GH; n ؍ 9), (3) GH and daily calcitriol (D) at 50 ng/kg per d (Nx-Phos؉GH؉daily D; n ؍ 8), (4) GH and intermittent D (three times weekly) at 350 ng/kg per wk (Nx-Phos؉GH؉int D; n ؍ 9), and (5) intact-control (n ؍ 10). Serum parathyroid hormone (PTH) levels were elevated in Nx-Phos, but IGF-I levels did not change with growth hormone. Body length, tibial length, and growth plate width did not increase with either GH or calcitriol. Proliferating cell nuclear antigen staining, PTH/PTHrP receptor, bone morphogenetic protein-7, and fibroblast growth factor receptor-3 expression increased with GH alone or with intermittent calcitriol but were slightly diminished during daily calcitriol administration. GH enhanced IGF-I, IGF binding receptor-3, and GH receptor but declined with daily and intermittent calcitriol. Overall, there was no improvement in body length, tibial length, and growth plate width at the end of GH therapy, but selected markers of chondrocyte proliferation and chondrocyte differentiation increased, although these changes were attenuated by calcitriol. The combination of GH and calcitriol that is frequently used in children with renal failure and secondary hyperparathyroidism require further studies to evaluate the optimal dose and frequency of administration to increase linear growth and prevent bone disease. G rowth hormone (GH) is a potent mitogenic agent that is frequently used to increase linear growth in children with chronic renal failure. The growth response, however, remains suboptimal in children who are maintained on chronic dialysis therapy compared with predialysis patients who are on conservative medical treatment (1). Causative factors that may contribute to the poor response to GH in dialysis children include a greater degree of GH insensitivity, increased severity of secondary hyperparathyroidism, differences in skeletal histology, concurrent treatment with vitamin D, and high doses of calcium salts.GH stimulates proliferation in various types of cells, including chondrocytes and osteoblasts, and increases collagen production either directly by binding to the GH receptor (GHR) or indirectly by increasing hepatic and local IGF-I production (2-4). Calcitriol (1,25-dihydroxyvitamin D 3 ) is used on a regular basis to maintain normocalcemia, control the development and progression of secondary hyperparathyroidism, and prevent renal bone disease in pediatric patients with chronic renal failure. Studies have shown that calcitriol exerts a dose-dependent antiproliferative effect on chondrocytes and osteoblasts (5). Mehls et al. (6) demon...