Catch-up growth with normal parathyroid hormone levels in chronic renal failure

Abstract

The optimum range for parathyroid hormone (PTH) levels in children with chronic renal failure (CRF) remains undefined. We aimed to determine growth velocity in children with CRF managed with normal PTH levels. We performed a retrospective case note review of 99 children (77 boys), with a glomerular filtration rate (GFR) <41 ml/min per 1.73 m(2), who had at least 2 years of 3-monthly follow-up. The age range at entry was 0.5-6.0 years; data collection was continued until 10 years of age or the commencement of growth hormone or renal replacement therapy. The median GFR was 22 ml/min per 1.73 m(2); over the study period mean serum calcium and phosphate levels were approximately equal to the mid-point of the respective normal ranges. Median PTH levels were equal to the upper limit of the normal range. Height standard deviation score (Ht SDS) at entry was -1.73. During the study period the overall mean change in Ht SDS was +0.3, significantly greater than the no change expected of a normal population ( P=0.004). The median dose of calcium carbonate was 150 mg/kg per day and 1-alpha calcidol 0.015 microg/kg per day. The growth rate was independent of all parameters, including age, PTH levels, the use of enteral feeds, and 1-alpha calcidol prescription. Our results indicate that catch-up growth can occur in infants and children with CRF when medical therapy is aimed at normalizing PTH levels.

Growth and PTH in prepubertal children on long-term dialysis

“…Height at the start of dialysis was significantly reduced, and was similar both to other studies from our unit, which showed infants and children with CRF or ESRF on dialysis or transplanted to have a HtSDS ranging from −1.73 to −2.9 [7][8][9], and to NAPTRCS data [3], which showed a HtSDS in the first month after initiation of dialysis of −1.99 at age 0-1 years, −2.05 at age 2-5, and −1.71 at age 6-12 years (−1.64 overall). However, despite this, growth was maintained in our patients, without further decline in HtSDS after starting dialysis.…”

“…We have shown that catch-up growth can be achieved with these regimens in children with CRF [7] and in infants and children on dialysis [8][9][10]. In this study we have looked at the effect of our policy on growth in prepubertal children on longterm dialysis.…”

“…However, in one small study of ten children treated with intensive dialysis and nutrition without growth hormone (rhGH), HtSDS improved by 0.32 over one year [6]. There has been little improvement in height prognosis over the last ten years [7], although recent data suggests an improvement in HtSDS at the onset of dialysis, particularly in children over 6 years of age [3].…”

A structural approach to the assessment of fracture risk in children and adolescents with chronic kidney disease

“…It has been suggested that intermittent calcitriol therapy combined with calcium-containing phosphate binders may adversely affect chondrocyte activity in the epiphyseal growth plate, with a consequent reduction in linear growth. Studies on the relations between adynamic bone, suppression of PTH with vitamin D therapies, and growth in children have yielded conflicting results [15][16][17].…”

Early Skeletal and Biochemical Alterations in Pediatric Chronic Kidney Disease

“…Serum parathyroid hormone (PTH) levels are used as a biomarker of bone turnover; however, current treatment recommendations are opinion based and controversial in pediatric patients with predialysis CKD (2,3). Some data suggest that optimal growth is associated with serum PTH levels within the normal range (4), whereas other studies have demonstrated the greatest growth velocity at higher PTH levels (5). Although PTH levels are currently used to guide therapy with active vitamin D sterols, little information exists as to the relationship between PTH and indices of bone turnover and mineralization in children with mild and moderate stages of CKD.…”