EXCESSIVE DIETARY-PROTEIN AND SUBOPTIMAL CALORIC-INTAKE HAVE A NEGATIVE EFFECT ON THE GROWTH OF CHILDREN WITH CHRONIC RENAL-DISEASE BEFORE AND DURING GROWTH-HORMONE THERAPY

Although diet and nutrition are an integral part of the management of individuals with chronic renal failure (CRF), little has been written on the effect of nutrition on the growth response to growth hormone (G H) in CRF. We studied the GH axis and nutritional status of 31 prepube rtal children aged 8.7 +/- 0.5 years with a height standard deviation score (SDS) of -3.2 +/- 0.2 (mean +/- SEM) with CRF. Sixteen CRF patie nts on hemodialysis and 15 on peritoneal dialysis were studied, Forty- four age-matched normal short children without GH deficiency served as controls, Spontaneous 12-hour GH and stimulated GH values were signif icantly higher and GH binding protein (GHBP) was significantly lower i n the CRF patients than in the normal short children. Both before the initiation of GH therapy and after the first year of treatment, the gr owth velocity (SDS) was inversely correlated with dietary protein inta ke and positively correlated with caloric intake. GH was administered at a dosage of 28 and 21 IU/m(2)/wk to the CRF group and the normal sh ort children, respectively, divided into seven daily doses. The growth response of the normal short children was significantly greater than that of the CRF patients. GH therapy induced a smaller increment in GH BP and IGF-I in the CRF patients versus the normal short children (8.8 +/- 2.2 and 10.2 +/- 2.7 v 24.8 +/- 1.3 and 27.6 +/- 2.5 nmol/L, resp ectively, P < .01). The 1-year growth velocity of the CRF children was most closely correlated with dietary protein and caloric intake. The nutritional status of CRF patients is concluded to be a major factor i n growth both before and during GH therapy. Copyright (C) 1998 by W.B. Saunders Company.