Accelerated growth in short children with chronic renal failure treated with both strict dietary therapy and recombinant growth hormone

Abstract

In a 12-month study, nine boys, aged 4.8-15.6 years, with bone ages 4.6-13 years, with moderate to severe chronic renal failure and resultant growth failure were treated with daily recombinant human growth hormone (rhGH), in conjunction with a strict low-protein/low-phosphate diet supplemented with keto and amino forms of the essential amino acids, histidine and additional energy. Improved growth had previously been observed with this dietary management over that obtained with conventional treatment for chronic renal failure. Each child had been on this diet for at least 2 years before rhGH was commenced. Mean height velocity increased from 4.6 +/- 1.3 to 9.0 +/- 1.3 cm/year (P < 0.001) in the pre-pubertal group, and in the pubertal group from 5.4 +/- 1.4 to 10.4 +/- 1.8 cm/year (P < 0.01). The mean height velocity standard deviation scores (SDSs) increased from -1.2 +/- 0.6 to +2.3 +/- 0.9 (P < 0.001) in the pre-pubertal group and from -0.4 +/- 0.6 to +1.9 +/- 1.1 (P < 0.01) in the pubertal group. Mean height SDS for chronological age increased from -2.2 +/- 0.7 to -1.5 +/- 0.5 (P < 0.01) in the pre-pubertal group and from -1.9 +/- 0.7 to -1.3 +/- 0.9 in the pubertal group (P < 0.02). There was no significant deterioration in renal function or renal bone disease, and bone age did not advance more than chronological age over the 12-month period.

Growth Retardation in Children with Chronic Renal Failure

“…Initial short-term studies in children with growth failure associated with CRF demonstrated accelerated linear growth during treatment with rhGH. (74,(96)(97)(98)(99)(100) Data from subsequent placebo-controlled studies in the United States and Europe confirmed the results of previous uncontrolled rhGH trials. (75,101) A multicenter randomized double-blind placebo-controlled study in children with CRF demonstrated marked improvement in linear growth in the rhGHtreated group compared with the placebo-control group.…”

Evaluation of clinical and laboratory parameters during 2 years of growth hormone treatment in prepubertal children with chronic renal failure

“…No detrimental effects of GH on renal function have been reported in previous studies [5,16,20,4] including a placebo-controlled trial [3]. In contrast, a review of European studies revealed a small but significant fall in GFR during treatment [6].…”

Growth Retardation in Children with Chronic Renal Insufficiency

“…This concern was [28] 5.0 ± 1.4 8.5 ±1.3 0.0001 TönsholTet al [29] 4.3 10.0 <0.001 Van Es [30] 4.2 9.8 Van Reenen et al [31] 4.6 ± 1.3 9.0 ±1.3 <0.001 5.4 ±1. 4 10.4 ± 1.8' <0.01 TönsholT et al [32] 4.6 9.7 <0.03 Fine [33] 5.4±2.2 8.9 ±1.6 <0.00005…”