GROWTH-HORMONE TREATMENT INCREASES CIRCULATING LIPOPROTEIN(A) IN CHILDREN WITH CHRONIC-RENAL-FAILURE

Cardiovascular disease is the major cause of death in chronic renal fa ilure (CRF) patients managed by dialysis or kidney transplantation. Wh ilst the use of human growth hormone (hGH) is of established benefit i n CRF children particularly in those with short stature, in the presen t study we assessed in CRF children the effect of hGH treatment on cir culating lipoprotein(a) [Lp(a)], a genetically determined cardiovascul ar risk factor, We studied 15 CRF children treated by dialysis or conv entional therapy and after kidney transplantation. Overnight fasting b lood samples were collected immediately before and after 6 months hGH treatment, In all but one of the children there was a significant incr ease in serum Lp(a) over the 6 month treatment period - +66.7% over th e basal levels (range 14 to 180%), After the hGH treatment, in six chi ldren Lp(a) levels were elevated to above 300 mg/l, the cut-off level for increased coronary artery disease (CAD) risk, Concomitantly/childr en also had an increase in serum levels of IGF-I (+96.4%) and insulin (+85.8%), All children had an accelerated growth velocity during the t reatment; there was no effect on serum creatinine, Our study shows tha t hGH treatment in CRF children, though beneficial in its growth promo ting effects, increases the already characteristically high levels of serum Lp(a), a risk factor for CAD, and that serum Lp(a) monitoring du ring treatment with hGH may be useful in evaluating future cardiovascu lar risk.