Growth hormone for children with chronic kidney disease

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Vimalachandra D, Hodson EM, Willis NS, Craig JC, Cowell C, Knight JF
Growth hormone for children with chronic kidney disease
Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD003264. DOI: 10.1002/14651858.CD003264.pub2.

The purpose of this review and meta-analysis was to evaluate the benefits and harms of recombinant human growth hormone (rhGH) treatment in children with chronic kidney disease (CKD). Children with CKD are at risk for kidney failure and can end up requiring dialysis or a kidney transplant. One of the complications of CKD is growth retardation. Growth hormone (rhGH) has been used to help children grow to a more average height for their age but there are concerns that treatment with rhGH may have adverse effects on kidney function, predispose the child to kidney transplant rejection and cause intracranial hypertension.

This review analyzed randomized controlled clinical trials which were identified from the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, article reference lists and through contact with local and international experts in the field. The reviewers assessed studies for methodological quality and extracted data from fifteen trials that met the selection criteria.

The selected trials included 629 children less than 18 years of age, who had been diagnosed with CKD, and were pre-dialysis, on dialysis or post-transplant. The selected trials compared rhGH treatment with placebo/no treatment or growth hormone treatments with two different doses of rhGH. All of the trials also included height outcomes.

Treatment with rhGH at a dose of 28 IU/m²/week resulted in a significant increase in height standard deviation score (SDS) at one year and a significant increase in height velocity at six months and one year. Those children treated with a lower dose of rhGH (14 IU/m²/week) had a significantly lower increase in height velocity than the higher dose group. The frequency of reported side effects in those treated with rhGH, were similar to that of the control group.

The review of trials found that rhGH increased height in children with CKD by about 4 cm to 6 cm with 1-2 years of treatment and that adverse effects are very rare. The trials were too short to determine if continuing treatment resulted in an increase in final adult height.