Abstract
Infants with chronic renal failure (CRF) are at high risk of experiencing severe growth retardation. We report a study of 12 infants with CRF who have been treated with recombinant human growth hormone (rhGH) since the age of 0.5 ± 0.3 years. A control group comprised 15 infants with less severe CRF who were being treated during the same period, but who did not receive rhGH. Despite the infants in the rhGH group had more severe renal failure, they grew at least as well as those in the control group and experienced catch-up growth that started earlier and was more sustained; they also gained more weight. Between the age of 0.5 and 2.5 years, the height standard deviation score (HtSDS) improved from −2.0 ± 1.2 to −0.9 ± 0.9 in the rhGH group (p < 0.005) and from −1.6 ± 1.6 to −1.0 ± 1.9 in the control group (p=non significant, n.s.). The average gain in HtSDS was +1.1 ± 0.8 in the treated group and +0.6 ± 1.4 in the control group (p = n.s.). During the same period, the weight SDS improved from −2.2 ± 0.9 to −0.6 ± 1.2 (p < 0.005) and from −1.9 ± 1.2 to −1.3 ± 1.2 (p=n.s.) in the treatment and control groups, respectively. Nutritional intake was similar in both groups, while parathyroid hormone levels tended to increase, although not significantly, after rhGH treatment (p=n.s.). The results of this pilot study suggest that very early treatment with rhGH in patients with early-onset CRF may improve growth.
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References
Haffner D, Schaefer F, Nissel R, Wühl E, Tönshoff B, Mehls O (2000) Effect of growth hormone treatment on the adult height of children with chronic renal failure. German study group for growth hormone treatment in chronic renal failure. N Engl J Med 343:923–930
Mahan JD, Warady BA (2008) Assessment and treatment of short stature in pediatric patients with chronic kidney disease: a consensus statement. Pediatr Nephrol 21:917–930
Mahesh S, Kaskel F (2008) Growth hormone axis in chronic kidney disease. Pediatr Nephrol 23:41–48
Kleinknecht C, Broyer M, Huot M, Marti-Henneberg C, Dartois AM (1983) Growth and development of nondialyzed children with chronic renal failure. Kidney Int 24[Suppl 15]:S40–S47
Rees L, Rigden SPA, Ward GM (1989) Chronic renal failure and growth. Arch Dis Child 64:573–577
Fine RN, Kohaut E, Brown D, Kuntze J, Attie KM (1996) Long-term treatment of growth retarded children with chronic renal insufficiency, with recombinant human growth hormone. Kidney Int 49:781–785
Vimalachandra D, Craig JC, Cowell CT, Knight JF (2001) Growth hormone treatment in children with chronic renal failure: a meta-analysis of randomized controlled trials. J Pediatr 139:560–567
Maxwell H, Rees L (1996) Recombinant human growth hormone treatment in infants with chronic renal failure. Arch Dis Child 74:40–43
Hokken-Koelega A, Mulder P, De Jong R, Lilien M, Donckerwolcke R, Groothof J (2000) Long-term effects of growth hormone treatment on growth and puberty in patients with chronic renal insufficiency. Pediatr Nephrol 14:701–706
Tonshoff B, Mehls O (1995) Growth retardation in children with chronic renal insufficiency: current aspects of pathophysiology and treatment. J Nephrol 8:133–142
Kaskel F (2003) Chronic renal disease: a growing problem. Kidney Int 64:1141–1151
Karlberg J, Schaefer F, Hennicke M, Wingen AM, Rigden S, Mehls O (1996) Early age-dependent growth impairment in chronic renal failure. European study group for nutritional treatment of chronic renal failure in childhood. Pediatr Nephrol 10:283–287
Van Dyck M, Sidler S, Proesmans W (1998) Chronic renal failure in infants: effect of strict conservative treatment on growth. Eur J Pediatr 157:759–762
Kopple JD, National Kidney Foundation K/DOQI Work Group (2001) The National Kidney Foundation K/DOQI clinical practice guidelines for dietary protein intake for chronic dialysis patients. Am J Kidney Dis 38[Suppl 1]:S68–S73
United States growth charts. National Center for Health Statistics, Center for Disease Control. Available at https://doi.org/www.cdc.gov/nchs/about/major/nhanes/growthcharts/datafiles.htm
Guerlich WW, Pyle SI (1959) Radiographic atlas of skeletal development of the hand and wrist. Stanford University Press, Stanford, California
Schwartz GJ, Brion LP, Spitzer A (1987) The use of plasma creatinine concentration for estimating glomerular filtration rate in infants, children, and adolescents. Pediatr Clin North Am 34:571–590
Fine RN, Attie KM, Kuntze J, Brown DF, Kohaut EC (1995) Recombinant human growth hormone in infants and young children with chronic renal insufficiency: Genentech Collaborative Study Group. Pediatr Nephrol 9:451–457
Kari JA, Gonzalez C, Ledermann SE, Shaw V, Rees L (2000) Outcome and growth of infants with severe chronic renal failure. Kidney Int 57:1681–1687
Fine RN, Ho M, Tejani A, Blethen S (2003) Adverse events with rhGH treatment of patients with chronic renal insufficiency and end-stage renal disease. J Pediatr 142:539–545
Bérard E, Crosnier H, Six-Beneton A, Chevallier T, Cochat P, Broyer M (1998) Recombinant human growth hormone treatment of children on hemodialysis. French Society of Pediatric Nephrology. Pediatr Nephrol 12:304–310
Maxwell H, Rees L (1998) Randomised controlled trial of recombinant human growth hormone in prepubertal and pubertal renal transplant recipients. British association for pediatric nephrology. Arch Dis Child 79:481–487
Picca S, Cappa M, Martinez C, Moges SI, Osborn J, Perfumo F, Ardissino G, Bonaudo R, Montini G, Rizzoni G (2004) Parathyroid hormone levels in pubertal uremic adolescents treated with growth hormone. Pediatr Nephrol 19:71–76
Oh J, Wunsch R, Turzer M, Bahner M, Raggi P, Querfeld U, Mehls O, Schaefer F (2002) Advanced coronary and carotid arteriopathy in young adults with childhood-onset chronic renal failure. Circulation 106:100–105
Civilibal M, Caliskan S, Adaletli I, Oflaz H, Sever L, Candan C, Canpolat N, Kasapcopur O, Kuruoglu S, Arisoy N (2006) Coronary artery calcifications in children with end-stage renal disease. Pediatr Nephrol 10:1426–1433
Rees L (2008) What parathyroid hormone levels should we aim for in children with stage 5 chronic kidney disease; what is the evidence? Pediatr Nephrol 23:179–184
Silverstein DM, Kher KK, Moudgil A, Khurana M, Wilcox J, Moylan K (2008) Cinacalcet is efficacious in pediatric dialysis patients. Pediatr Nephrol 23:1817–1822
Muscheites J, Wigger M, Drueckler E, Fischer DC, Kundt G, Haffner D (2008) Cinacalcet for secondary hyperparathyroidism in children with end-stage renal disease. Pediatr Nephrol 23:1823–1829
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Mencarelli, F., Kiepe, D., Leozappa, G. et al. Growth hormone treatment started in the first year of life in infants with chronic renal failure. Pediatr Nephrol 24, 1039–1046 (2009). https://doi.org/10.1007/s00467-008-1084-7
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DOI: https://doi.org/10.1007/s00467-008-1084-7