Recombinant human growth hormone treatment of children on hemodialysis

Abstract

Forty-two children, aged 2-21.5 years on hemodialysis with a height below -2.0 standard deviation score (SDS) for age, were selected to receive recombinant human growth hormone (rhGH) therapy at 17 French centers. Of the 42 children, 36 were prepubertal and 8 were in early puberty (testicular volume between 4 and 8 ml for boys, breast development B2 or B3 in girls). All received 1 IU/kg per week by daily subcutaneous injection for 1-5 years. The year before rhGH therapy served as a control period. During the 1st year of treatment, mean growth velocity increased from 3.5 to 7.0 cm/year (P < 0.0001) and was always over 2.5 cm/year. This velocity allowed a catch-up growth of +0.5 height SDS. Neither weight nor the body mass index varied compared with the pretreatment year. No change was observed in urea, creatinine, or glucose tolerance. The mean increment in bone age was 0.9 years. The mean growth velocity decreased over subsequent years (P < 0.0001), but remained higher than the prestudy velocity. A significant negative correlation was observed during the 1st year between the increase in growth velocity and the prestudy velocity (P < 0.0001), with the least gain in patients who had the best spontaneous velocity. Pubertal status had no influence on response to rhGH. No significant side effects were observed during the 103 treatment-years. Five patients developed secondary hyperparathyroidism and 1 suffered from acute pancreatitis, but the relationship with rhGH therapy remains uncertain. rhGH therapy appears indicated for children on hemodialysis, even though the potential benefits appear somewhat lower for those with a spontaneous growth velocity over 6 cm/year.

Long-term results of rhGH treatment in children with renal failure: experience of the French Society of Pediatric Nephrology

“…In their study, however, the authors did not analyze the impact of CRI status, which is clearly correlated to age. We also failed to find any influence on SDS gain for gender or pubertal status, as reported in other studies [4,5,[8][9][10]. This finding could be the consequence of our limited population.…”

“…Between January 1991 and April 1993, 251 patients of the 22 pediatric nephrology units in France (Amiens, Angers, Besançon, Clermont-Ferrand, Dijon Lille, Lyon, Marseille, Montpellier, Nancy, Nantes, Nice, Paris-Hôpital R. Debré, ParisHôpital des Enfants Malades, Paris-Hôpital A. Trousseau, Reims, Rennes, Roscoff, Rouen, Strasbourg, Toulouse, and Tours) met the criteria for trials and were enrolled in one of the three trials. Certain short-term results of the HD and RT cohorts have been reported previously [4,5].…”

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

“…The etiology is multifactorial and includes inadequate nutrition, metabolic acidosis, renal osteodystrophy, and disturbances in the growth hormone-insulin-like growth factor (IGF)-1 axis [1]. The beneficial effect of recombinant human growth hormone (rhGH) in improving linear growth in children with CKD is well established [2][3][4]. Moreover, use of rhGH leads to improved adult height in children with CKD [5].…”

Acute Pancreatitis in a Girl with Panhypopituitarism Due to Craniopharyngioma on Growth Hormone Treatment. A Combination of Risk Factors

“…It is well known that hyperlipemia (hypercholesterolemia, hypertriglyceridemia) is associated with acute pancreatitis, both as a precipitant and as an epiphenomenon [13, 14]. Furthermore, the increased incidence of acute pancreatitis during rhGH therapy (targeted event) [15,16,17,18,19,20], even though a rare adverse effect, is possibly caused by increased enzyme production (e.g., amylase, lipase and elastase) [21]. Moreover, this event seems to be more frequent in Turner syndrome than in other non-Turner syndrome patients on rhGH treatment [22].…”