LONG-TERM TREATMENT OF GROWTH-RETARDED CHILDREN WITH CHRONIC RENAL-INSUFFICIENCY, WITH RECOMBINANT HUMAN GROWTH-HORMONE

Long-term (5 years) treatment of 20 growth-retarded pre-pubertal child ren with chronic renal insufficiency (CRI) led to a significant (P < 0 .00005) improvement in standardized height from -2,6 at baseline to -0 .7 at five years. Eight patients were paused after reaching target hei ght (50th centile mid-parental height) and 4 (50%) required re-initiat ion of recombinant human growth hormone (rhGH) because of a substantia l decrease in standardized height. Growth potential was not adversely impacted with a Delta height age (HA) minus Delta bone age (BA) at fiv e years of +0.5 (N = 8). The mean calculated Cc, decreased from 32.2 /- 15.2 ml/min/1.73 m(2) at baseline to 24.6 +/- 14.7 ml/min/1.73 m(2) at five pears (P = 0.04), which would be consistent with the natural history of CRI in children. Despite the absence of clinical consequenc es, the increase in the mean fasting and two-hour post-prandial plasma insulin levels during treatment compared to baseline requires further investigation. The only clinically significant adverse event potentia lly related to rhGH was the development of avascular necrosis of the f emoral head during the fourth year of treatment in one patient. Long-t erm rhGH treatment in children with CRI improves the potential of chil dren with CRI achieving target adult height.