RECOMBINANT HUMAN GROWTH-HORMONE THERAPY IN MALNOURISHED DIALYSIS PATIENTS - A RANDOMIZED CONTROLLED-STUDY

Recombinant human growth hormone (rhGH; Saizen, Serono, Spain) has bee n recently used as an anabolic agent in several catabolic states, incl uding malnourished chronic dialysis patients. However, up-to-date, com parative studies with control groups of dialysis patients have not bee n reported. The aim of the present study was to assess the effects of rhGH on nutritional status in a group of malnourished adult chronic di alysis patients undergoing both continuous ambulatory peritoneal dialy sis (CAPD) and hemodialysis (HD). The patients were randomly assigned to the control group (nine patients; 6 women, 3 men; mean age, 58.3 +/ - 5.6 years; seven undergoing CAPD, two undergoing HD) or the rhGH gro up (eight patients; three women, five men; mean age, 63.9 +/- 3.1 year s; four undergoing CAPD, four undergoing HD). Both groups were similar at baseline. All patients were given dietary prescriptions (35 kcal/k g/d and 1 g protein/kg ideal body weight/d) during 4 weeks. In the rhG H group, rhGH was administered at 0.2 IU/kg/d subcutaneously (SC) duri ng this period. Anthropometric and analytic parameters were assessed b efore (0 weeks) therapy and at 2 and 4 weeks after starting therapy. T he rhGH group showed an increase of 1.238 kg in body weight from 64.3 +/- 4.3 (mean +/- standard error of the mean [SEM]) to 65.6 +/- 4.9 kg (P < 0.05). Serum insulin-like growth factor type 1 (IGF-1) concentra tions increased from 216.6 +/- 42.5 to 581.2 +/- 171.5 ng/mL (4 weeks; P < 0.01) and transferrin levels increased from 271.2 +/- 16.3 to 314 .5 +/- 21.2 mg/dL (4 weeks; P < 0.05). A significant reduction in bloo d urea nitrogen (BUN) level was observed (62.1 +/- 1.8 v 46.8 +/- 3.8 mg/dL; 4 weeks; P < 0.05). Mean daily protein intake, determined by in dividual dietary survey, at 0 and 4 weeks, remained constant in both g roups. In conclusion, weight gain and IGF-1 and transferrin level incr eases and BUN level decreases, despite the constant oral intake, sugge st that short-term rhGH administration is associated with an anabolic reaction in malnourished dialysis patients. (C) 1998 by the National K idney Foundation, Inc.