LOW-DOSE GROWTH-HORMONE THERAPY DURING PERITONEAL-DIALYSIS OR FOLLOWING RENAL-TRANSPLANTATION

The minimal effective dose of growth hormone (GH) to promote growth in children on dialysis or following renal transplantation remains unset tled. In order to study the issue, ''low-dose'' GH was administered to children with end-stage renal disease (ESRD) receiving chronic automa ted peritoneal dialysis (APD, n = 6, 4 males, 2 females) or following renal transplantation (T, n = 9, 8 males, 1 female). No APD patient wa s GH deficient, while 1 T patient (no. 2) had data consistent with GH deficiency, although he was obese (body mass index = 34 kg/m(2)). The mean dose of GH after 6 and 12 months of treatment was 0.16+/-0.02 and 0.22+/-0.07 versus 0.16+/-0.03 and 0.27+/-0.21 mg/kg per week for APD and T patients, respectively. When analyzing all patients, there were no significant differences before or after 6 and 12 months of GH ther apy within or between the two groups, in terms of height velocity, bon e age, renal function (in the T group) and height Z-scores (Z-Ht). How ever, the height velocity Z-score (Z-HV) increased significantly at 6 and 12 months compared with baseline in the APD patients only (P < 0.0 5). When the 2 T patients with the most impaired renal function were e xcluded from the analysis, Z-HV also increased significantly in the T patients after 12 months of GH (P < 0.02). We conclude that following ''low-dose'' GH therapy, children with ESRD treated with APD or T have similar increases in HV, allowing maintenance of Z-Ht but not ''catch -up'' growth.