Double-blind, placebo-controlled study of growth hormone treatment in elderly patients undergoing chronic hemodialysis: Anabolic effect and functional improvement

Elderly patients with end-stage renal disease often have protein and/or cal oric malnutrition that severely affects general well-being and mortality. U remia is associated with resistance to the action of growth hormone (GH). T his resistance could be of clinical importance in elderly dialysis patients . In the present study, the effects of GH treatment were assessed in elderl y patients receiving chronic hemodialysis, Twenty hemodialysis patients wit h a mean age of 71.7 years (range, 53 to 92 years) were included on a 6-mon th, randomized, double-blind, placebo-controlled trial of GH treatment, The dose of GH was 66.7 mu g/kg, administered subcutaneously three times weekl y immediately after each dialysis session. Body composition was measured us ing total-body potassium levels, computed tomography of the lower leg, and bioelectrical impedance analysis. Serum albumin concentrations and handgrip strength were also measured. GH treatment increased the serum concentratio n of insulin-like growth factor-I (IGF-I), IGF-I/IGF-binding protein-3 rati o, fat-free mass, and the serum concentration of albumin compared with plac ebo. The number of patients with serum albumin levels less than 40 g/L was reduced by a factor of three in the GH-treated group. Handgrip strength inc reased in response to GH treatment compared with placebo. Six months of GH treatment in elderly hemodialysis patients produced anabolic effects, with improved muscle performance. Also, the number of patients with low albumin levels was markedly reduced, indicating improved nutritional status and/or attenuated catabolism. These are ail important beneficial effects for indiv idual patient outcomes. (C) 1999 by the National Kidney Foundation, Inc.