Skip to main content

Advertisement

SpringerLink
Log in

Use of rhGH in children with chronic kidney disease: lessons from NAPRTCS

  • Original Article
  • Published:
Pediatric Nephrology Aims and scope Submit manuscript

Abstract

We evaluated the utilization and potential benefits of recombinant human growth hormone (rhGH) in children with chronic kidney disease (CKD) and following renal transplantation in a large patient cohort. We queried the chronic renal insufficiency (CRI), dialysis, and transplant registries of the North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS) to characterize the frequency of rhGH utilization, factors related to its usage, and the relationship between rhGH usage and catch-up growth. Data from 6,505, 5,122, and 4,478 CRI, dialysis, and transplant patients, respectively, was evaluated. Percentage utilization of rhGH 2 years after registry entry was 22%, 33%, and 3% in children with a height standard deviation score (SDS) <−1 and age <17 years (termed candidate group) in CRI, dialysis, and transplant patients, respectively. Multivariate logistic regression analysis showed that the likelihood of using rhGH was significantly correlated with age, gender, geographical region of residence and height category within the candidate group (p < 0.01). The use of rhGH was associated with catch-up growth in 27%, 11%, and 25% of candidate CRI, dialysis, and transplant patients, respectively. In the candidate group, percentage catch-up growth was highest in children who were Tanner stage 1–2, who comprised 19.4%, 7.1%, and 25.5% of the CRI, dialysis, and transplant patients, respectively. Using multiple regression analysis, the estimated impact of rhGH on final adult height (age >19 years) was 0.80, 0.50, and 0.19 SDS, in CRI, dialysis, and transplant patients, respectively. Thus, rhGH can improve height gain in some children with CKD. The use of rhGH appears to be most effective in prepubertal children with CRI.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Abbreviations

NAPRTCS:

North America Pediatric Renal Trial and Collaborative Studies

CRI:

chronic renal insufficiency

SDS:

standard deviation score

rhGH:

recombinant human growth hormone

CKD:

chronic kidney disease

ClCr :

estimated creatinine clearance

US:

United States

References

  1. Seikaly MG, Ho PI, Emmett L, Fine RN, Tejani A (2003) Chronic renal insufficiency in children: Annual report of NAPRTCS. Pediatr Nephrol 18:796–804

    Article  PubMed  Google Scholar 

  2. Seikaly MG, Salhab N, Gipson D, Yiu V, Stablein D (2006) Stature in children with chronic kidney disease: analysis of NAPRTCS database. Pediatr Nephrol 21:793–799

    Article  PubMed  Google Scholar 

  3. Roelfsema V, Clark RG (2001) The growth hormone and insulin-like growth factor axis: its manipulation for the benefit of growth disorders in renal failure. J Am Soc Nephrol 12:1297–1306

    CAS  PubMed  Google Scholar 

  4. Mahan JD, Warady BA (2006) Assessment and treatment of short stature in pediatric patients with chronic kidney disease: a consensus statement. Pediatr Nephrol 21:917–930

    PubMed  Google Scholar 

  5. 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

    Article  CAS  PubMed  Google Scholar 

  6. Cockroft DW, Gault MH (1976) Prediction of creatinine clearance from serum creatinine. Nephron 16:31–41

    Article  Google Scholar 

  7. Schwartz GJ, Haycock GB, Edelmann CM Jr, Spitzer A (1976) A simple estimate of glomerular filtration rate in children derived from body length and plasma creatinine. Pediatrics 58:259–263

    CAS  PubMed  Google Scholar 

  8. United States growth charts. National Center for Health Statistics, Center for Disease Control. https://doi.org/www.cdc.gov/nchs/about/major/nhanes/growthcharts/datafiles.htm

  9. Maxwell H, Rees L (1998) Randomized 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

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. National Kidney Foundation (2002) K/DOQI Guidelines. Am J Kidney Dis 39:S14–S214

    Article  Google Scholar 

  11. Hokken-Koelega AC, Saenger P, Cappa M, Greggio N (2001) Unresolved problems concerning optimal therapy of puberty in children with chronic renal diseases. J Pediatr Endocrinol Metab 14(Suppl 2):945–952

    PubMed  Google Scholar 

  12. Haffner D, Schaefer R, Nissel R, Wuhl E, Tönshoff B, Mehls O (2002) 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 28:923–930

    Google Scholar 

  13. Fine RN, Khaut EC, Brown D, Perlman AJ (1994) Growth after recombinant human growth hormone therapy in children with chronic renal failure: report of a multicenter and double-blind placebo-control study. J Pediatr 124:374–382

    Article  CAS  PubMed  Google Scholar 

  14. Powell DR, Liu F, Baker BK, Hintz RL, Lee PD, Durham SK (1997) Modulation of growth factors by growth hormone in children with chronic renal failure: the Southwest pediatric nephrology study group. Kidney Int 51:1970–1979

    Article  CAS  PubMed  Google Scholar 

  15. Fine RN, Attie KM, Kuntze J, Brown DF, Kohaut E (1995) Recombinant human growth hormone in infants and young children with chronic renal insufficiency. Pediatr Nephrol 9:451–457

    Article  CAS  PubMed  Google Scholar 

  16. Neu AM, Bedinger M, Fivush BA, Warady BA, Watkins SL, Friedman AL, Brem AS, Goldstein SL, Frankenfield DL (2005) Growth in adolescent hemodialysis patients: data from the centers for medicare & medicaid services ESRD clinical performance measures project. Pediatr Nephrol 20:1156–1160

    Article  PubMed  Google Scholar 

  17. Kari JA, Rees L (2005) Growth hormone for children with chronic renal failure and on dialysis. Pediatr Nephrol 20:618–621

    Article  PubMed  Google Scholar 

  18. Guest G, Berard E, Crosnier H, Chevallier T, Rappaport R, Broyer M (1998) Effects of growth hormone in short children after renal transplantation. French Society of Pediatric Nephrology. Pediatr Nephrol 12:437–446

    Article  CAS  PubMed  Google Scholar 

  19. Fine RN, Stablein D (2005) Long-term use of recombinant human growth hormone in pediatric allograft recipients: a report of the NAPRTCS transplant registry. Pediatr Nephrol 20:404–408

    Article  PubMed  Google Scholar 

  20. Fine RN, Sullivan EK, Kuntze J, Blethen S, Kohaut E (2000) The impact of recombinant human growth hormone treatment during chronic renal insufficiency on renal transplant recipients. J Pediatr 136:376–382

    Article  CAS  PubMed  Google Scholar 

  21. Tönshoff B, Mehls O (1995) Growth retardation in children with chronic renal insufficiency: current aspects of pathophysiology and treatment. J Nephrol 8:133–142

    Google Scholar 

  22. Fine RN, Ho M, Tejani A (2001). The contribution of renal transplantation to final adult height: a report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS). Pediatr Nephrol 16:951–956

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

We are indebted to the secretarial support of Ms. Sharon Blend.

Author information

Authors and Affiliations

  1. Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Mouin G. Seikaly

  2. Department of Pediatrics, Children’s Medical Center of Dallas, 1935 Motor Street, Dallas, TX, 75235, USA

    Mouin G. Seikaly & Nina Salhab

  3. Department of Pediatrics, Children’s Mercy Hospital, Kansas City, MO, USA

    Bradley A. Warady

  4. Department of Pediatrics, The EMMES Corporation, Rockville, MD, USA

    Donald Stablein

Authors
  1. Mouin G. Seikaly
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nina Salhab
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bradley A. Warady
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Donald Stablein
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mouin G. Seikaly.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Seikaly, M.G., Salhab, N., Warady, B.A. et al. Use of rhGH in children with chronic kidney disease: lessons from NAPRTCS. Pediatr Nephrol 22, 1195–1204 (2007). https://doi.org/10.1007/s00467-007-0497-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00467-007-0497-z

Keywords

Search

Navigation