Obstacles to the prescribing of growth hormone in children with chronic kidney disease

Greenbaum, Larry A.; Hidalgo, Guillermo; Chand, Deepa H.; Chiang, Myra; Dell, Katherine MacRae; Kump, Theresa; Peschansky, Lena; Smith, Holly K.; Boyle, Mary; Kopf, Michelle; Metz, Lisa C.; Kamel, Margret; Mahan, John D.

doi:10.1007/s00467-008-0857-3

Cited by 34 publications

(18 citation statements)

References 13 publications

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“…In our study, children with short stature had a higher prevalence of Medicaid use, which may be a marker of lower socioeconomic status that could partially explain the higher mortality risk in shorter children despite transplantation. Other factors such as nonadherence to therapy and lower access to care, which are commonly associated with short stature in children with CKD (19)(20)(21), may also be underlying factors that could contribute to the elevated mortality risk in children with short stature.…”

Section: Discussionmentioning

confidence: 99%

Height at First RRT and Mortality in Children

Ku¹,

Fine

Hsu³

et al. 2016

CJASN

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Background and objectives Poor linear growth is common in children with CKD and has been associated with higher mortality. However, recent data in adult dialysis patients have suggested a higher risk of death in persons of tall stature. In this study, we aimed to examine the risk of all-cause and cause-specific mortality in children at both extremes of height at the time of first RRT.Design, setting, participants, & measurements Using the US Renal Data System, we performed a retrospective analysis of 13,218 children aged 2-19 years, who received their first RRT (dialysis or transplant) during 1995-2011. We used adjusted Cox models to examine the association between short (,3rd percentile) and tall (.3rd percentile) stature and risk of death, compared with less extreme heights.Results Over a median follow-up of 7.1 years, there were 1721 deaths. Risk of death was higher in children with short (hazard ratio, 1.49; 95% confidence interval, 1.33 to 1.66) and tall stature (hazard ratio, 1.32; 95% confidence interval, 1.03 to 1.69) in adjusted analysis. In secondary analyses, there was a statistically significant interaction between height and body mass index categories (P=0.04), such that the association of tall stature with higher mortality was limited to children with elevated body mass index (defined as $95th percentile for age and sex). Children with short stature had a higher risk of cardiac-and infection-related death, whereas children with tall stature had a higher risk of cancer-related death.Conclusions Children with short and tall stature are at higher mortality risk, although this association was modified by body mass index at time of first RRT. Studies to further explore the reasons behind the higher risk of mortality in children with extremes of height at the time of first RRT are warranted.

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Section: Discussionmentioning

confidence: 99%

Height at First RRT and Mortality in Children

Ku¹,

Fine

Hsu³

et al. 2016

CJASN

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“…40 The demand for daily injections and psychosocial factors are associated with low rGH use. [52][53][54] Children may reach normal final adult height if started on rGH therapy at an early age. Response to rGH therapy may vary.…”

Section: Recombinant Growth Hormone Therapy In Ckdmentioning

confidence: 99%

Endocrine Complications of Chronic Kidney Disease

Singh

Raed

Kari

2015

Chronic Renal Disease

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“…A recent report generated from a medical record review demonstrated that a rationale to explain the non-utilization of rhGH was not found in a substantial percentage of untreated patients [12]. Pertinent issues that may contribute to this poor utilization include the complexity of general CKD care, the need for longterm, daily rhGH injections, and difficulties with insurance authorization.…”

Section: Discussionmentioning

confidence: 99%

First-year response to rhGH therapy in children with CKD: a National Cooperative Growth Study Report

et al. 2010

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A clear definition of the appropriate growth response during recombinant human growth hormone (rhGH) treatment has never been established in the pediatric chronic kidney disease (CKD) population. We present here data from Genentech's National Cooperative Growth Study (NCGS) on the first-year growth response in prepubertal children with CKD. Using NCGS data, we constructed response curves for the first year of rhGH therapy in 270 (186 males, 84 females) naïve-to-treatment, prepubertal children with CKD prior to transplant or dialysis. Data from both genders were combined because gender was not significantly related to height velocity (p = 0.51). Response to rhGH was expressed as height velocity (HV) in cm/year. Mean, mean + or - 1SD, and mean - 2SD for HV during the first year of rhGH treatment as well as pretreatment HV were plotted versus age. Age-specific HV plots for rhGH-treated children with CKD are presented. At all ages, the first-year mean HV was greater than the mean pretreatment HV. The mean - 2SD for HV in children on rhGH treatment was similar to the mean pretreatment HV. These growth plots will be useful to clinicians for assessing a patient's first-year growth response. We propose that a HV below the mean - 1SD is an inadequate response. These curves may help identify patients with a suboptimal growth response due to confounding medical factors and/or non-compliance.

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Obstacles to the prescribing of growth hormone in children with chronic kidney disease

Cited by 34 publications

References 13 publications

Height at First RRT and Mortality in Children

Height at First RRT and Mortality in Children

Endocrine Complications of Chronic Kidney Disease

First-year response to rhGH therapy in children with CKD: a National Cooperative Growth Study Report

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