Abstract
Few publications have described the long-term effects of recombinant human growth hormone (rhGH) in uremic patients. This study reports the results of rhGH therapy at the end of treatment and at adult age in 178 French patients. At enrollment, 63 patients were under conservative treatment (CT), 40 under hemodialysis (HD), and 75 had a functioning renal transplant (RT). Under rhGH treatment, height velocities (HV) significantly increased in all patients, but the effect was significantly better in the CT group. The HV gain (HV under rhGH-HV before treatment) was similar in all three groups. Increases in HV allowed height standard deviation scores (SDS) catch up, and this effect persisted over a 5-year period. SDS height at the completion of treatment was significantly related to group (best in CT) and response to treatment during the first year. Data on adult height was available for 102 patients. Mean adult height was 162.2 cm in men and 152.9 cm in women, and 46% were > −2 SDS for height. Adult height SDS was correlated with height SDS and spontaneous HV before treatment and effect of treatment. Analysis of adult height in the 49 patients who entered the protocol with a height SDS between −2 and −3 (the current recommendation for rhGH use) revealed that 65% had an adult-height SDS >−2. These adult heights were significantly better if compared with historical cohorts of patients not treated by rhGH; rhGH significantly improves the adult-height prognosis of uremic patients suffering from growth retardation. Early rhGH administration during CT gives better height SDS at both the end of rhGH therapy and in adulthood.
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References
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
Seikaly MG, Salhab N, Warady BA Stablein D (2007) Use of rhGH in children with chronic kidney disease: lessons from NAPRTCS. Pediatr Nephrol 22:1195–1204
Mahesh S, Kaskel F (2008) Growth hormone axis in chronic kidney disease. Pediatr Nephrol 23:41–48
Berard 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
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
Tanner JM (1962) Growth at adolescence, 23nd Ed. Blackwell, Oxford
Sempé M, Pedron G, Roy-Pernot MP (1979) Auxologie: Méthodes et séquences. Theraplix
Tönshoff B, Mehls O, Heinrich U, Blum WF, Ranke MB, Schauer A (1989) Growth stimulating effects of recombinant growth hormone in children with end-stage renal disease. J Pediatr 116:561–566
Rees L, Ridgen SP, Ward G, Preece MA (1990) Treatment of short stature in renal disease with recombinant human growth hormone. Arch Dis Child 65:856–860
Johannson G, Sietnieks A, Janssens F, Proesmans W, Vanderschueren-Lodeweyckx M, Holmberg C, Sipilä I, Broyer M, Rappaport R, Albertsson-Wikland K, Berg U, Jodal U, Rees L, Ridgen SPA, Preece MA (1990) Recombinant human growth hormone treatment in short children with chronic renal disease, before transplantation or with functioning renal transplants. An interim report on five European studies. Acta Paediatr Scand 370(Suppl):36–42
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
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
Haffner D, Schaefer F, Nissel R, Wuhl E, Tonshoff 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
Fine RN, Sullivan EK, Tejani A (2000) The impact of recombinant human growth hormone treatment on final adult height. Pediatr Nephrol 14:679–681
Kari JA, Rees L (2005) Growth hormone for children with chronic renal failure and on dialysis. Pediatr Nephrol 20:618–621
Andre JL, Bourquard R, Guillemin F, Krier MJ, Briancon S (2003) Final height in children with chronic renal failure who have not received growth hormone. Pediatr Nephrol 18:685–691
Acknowledgements
The three trials mentioned in this article were launched by the pharmaceutical firms Kabi-Pharmacia, Sanofi, and Lilly. This report includes results obtained for French patients in the Kabi-Pharmacia International Growth Study. The authors thank Nancy Reed for help with translation of the manuscript.
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Members of the French Society of Pediatric Nephrology: J.L. André, A. Bensman, E. Bérard, J.P. Bertheleme, F. Bouissou, B. Boudailliez, F. Brou, M. Broyer, A. Burguet, G. Champion, P. Cochat, M. Dehennault, G. Deschênes, P. Desprez, R. Dumas, M. Fischbach, M. Foulard, M.T. Freycon, M.F. Gagnadoux, S. Gié, G. Guest, C. Guyot, G. Landthaler, M.P. Lavocat, C. Loirat, M.A. Macher, D. Morin, C. Mousson, P. Niaudet, H. Nivet, J.B. Palcoux, G. Picon, B. Roussel, M. Tsimaratos
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Bérard, E., André, J.L., Guest, G. et al. Long-term results of rhGH treatment in children with renal failure: experience of the French Society of Pediatric Nephrology. Pediatr Nephrol 23, 2031–2038 (2008). https://doi.org/10.1007/s00467-008-0849-3
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DOI: https://doi.org/10.1007/s00467-008-0849-3