PREDICTORS OF GROWTH-RESPONSE TO RHGH IN SHORT CHILDREN BEFORE AND AFTER RENAL-TRANSPLANTATION

Many children with chronic renal failure (CRF) present with a reduced height and a reduced height velocity resulting in diminished final hei ght irrespective of renal replacement therapy. Recombinant human growt h hormone (rhGH) has become a new treatment modality for short renal p atients, and the response to rhGH varies widely. In order to identify possible predictors of response to rhGH, the influence of sex, chronol ogical age, bone age, pubertal status, height and height velocity at b asal, target height, treatment modality for CRF, residual glomerular f iltration rate (GFR), and steroid treatment was analyzed by single and multiple regression analysis in 49 children prior to and after renal transplantation. During the first treatment year with 28 to 30 IU rhGH /M2/week given by daily s.c. injections, height velocity was highest i n patients on conservative treatment and lowest in patients on dialysi s. Height velocity expressed in cm/year was inversely correlated with age (r = -0.63; P < 0.0001) and positively correlated with pretreatmen t height velocity (r = 0.65; P < 0.0001). The increment in height velo city SDS (chronological age) was significantly negatively correlated w ith the pretreatment height velocity SDS (chronological age) (r = -0.5 8, P < 0.001), indicating that at any given age the slowest growing ch ildren tended to respond best to rhGH treatment. It is concluded that the response to rhGH is significantly influenced by age, pretreatment height velocity, and treatment modality for CRF, whereas the influence of other variables is less important.