ISSN 1662-4009 (online)

ESPE Yearbook of Paediatric Endocrinology (2018) 15 9.9 | DOI: 10.1530/ey.15.9.9

ESPEYB15 9 Oncology and chronic disease Growth, growth hormone and puberty in chronic diseases: novel insights from clinical practice (4 abstracts)

9.9 Growth hormone treatment improves final height and nutritional status of children with chronic kidney disease and growth deceleration

Bizzarri C , Lonero A , Delvecchio M , Cavallo L , Faienza MF , Giordano M , Dello Strologo L & Cappa M


Unit of Endocrinology, Bambino Gesù Children’s Hospital, Rome, Italy


To read the full abstract: J Endocrinol Invest. 2018;41:325-331

Growth failure is common in children with chronic kidney disease (CKD) and has a multifactorial etiology. The hypothalamus-pituitary axis is intact, but there is a resistance to growth hormone (GH) action in target tissues, secondary to decreased density of GH receptors, impaired signal transduction and reduced levels of free insulin-like growth factor 1 (IGF-1) due to increased levels of inhibitory IGF-binding proteins (IGFBPs). Additional factors contributing to growth deceleration include: severity and duration of CKD, ethnicity, primary renal disease, malnutrition, metabolic acidosis, renal osteodystrophy, and long-term steroid therapy (1-2). Several studies in children with CKD reported that growth hormone (rhGH) therapy increases height velocity, but data on final height are lacking. A recent systematic review summarized randomized controlled trials (RCTs) published 1966-2011 (3); rhGH therapy increased height velocity and height at 1 year, but all studies showed a consistent waning of effectiveness with longer treatment duration. No RCT reported final height data, but a few non-RCT studies suggested that rhGH improves final height (2-4). Haffner et al. (4) compared 38 initially prepubertal CKD children treated with rhGH (0.33 mg/kg weekly) for a mean of 5.3 years to 50 untreated CKD children. Mean final height of rhGH-treated children was 165 cm for boys and 156 cm for girls, which was 1.4 SD above their baseline height SDS. In contrast, the final height of untreated CKD children was 0.6 SD below their baseline height SDS. The North American Pediatric Renal Transplant Cooperative Study reported that final height SDS was higher in 513 rhGH-treated children (SDS = −1.83) than in 2263 concurrent untreated controls, (−2.60) (5). The French Society of Pediatric Nephrology reported that of 49 patients with a baseline height SDS between −2 to −3 (the French criteria for rhGH), 65% had an adult height >−2 SDS (6). Italian Medicine Agency criteria considers rhGH therapy for CKD children with height <−2 SDS and/or height velocity <25th percentile, in the absence of contraindications and is discontinued at renal transplantation. Therefore a new RCT with untreated controls is unethical. Despite the limitations of its retrospective and non-randomized design, the data suggest that rhGH-untreated patients manifest growth deceleration despite a better height SDS at baseline. On the contrary, height SDS of rhGH-treated patients progressively improved, and final height SDS was not different between the two groups. Moreover, rhGH treatment improved the deficit in BMI SDS from baseline to age at final height.

1. Olney RC. Mechanisms of impaired growth: effect of steroids on bone and cartilage. Horm Res 2009; 72 Suppl 1: 30–35.

2. Kidney Disease: Improving Global Outcomes (KDIGO) CKD work group KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int 2013; Suppl 3: 136–150.

3. Hodson EM, Willis NS, Craig JC. Growth hormone for children with chronic kidney disease. Cochrane Database Syst Rev. 2012. doi: 10.1002/14651858.CD003264.pub3

4. Haffner D, Schaefer F, Nissel R, Wühl E, Tönshoff B, Mehls O. Effect of growth hormone treatment on the adult height of children with chronic renal failure. N Engl J Med 2000; 343: 923–930.

5. Fine RN, Stablein D. Long term use of recombinant human growth hormone in pediatric allograft recipients: a report of the NAPRTCS transplant Registry. Pediatr Nephrol 2005; 20: 404–408.

6. Bérard E, André JL, Guest G, Berthier F, Afanetti M, Cochat P, Broyer M, French Society for Pediatric Nephrology. Long term result s of rhGH treatment in children with renal failure: experience of the French Society of Pediatric Nephrology. Pediatr Nephrol 2008; 23: 2031–2038.

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