Insulin-like growth factor I improves renal function in patients with end-stage chronic renal failure

There is no pharmacological treatment to increase the glomerular filtration rate in end-stage renal disease (ESRD). The administration of 100 mu g/kg of insulin-like growth factor (IGF) I twice a day to patients with ESRD inc reases inulin clearance. However, its effect is short-lived and IGF-I has m ajor side effects when given this way. To assess whether the use of a lower intermittent dose of IGF-I would effect sustained improved function with t olerable side effects we performed 1) a prospective open-labeled 24-day tri al in which we enrolled five patients and 2) a 31-day randomized, double-bl inded, placebo-controlled trial in which we enrolled 10 patients. Patients with ESRD [creatinine clearance of <15 ml . min(-1) . (1.73 m(2))(-1)] and scheduled to initiate renal replacement therapy received subcutaneous IGF-I , 50 mu g . kg(-1) . day(-1), or vehicle. Treatment with IGF I resulted in significantly increased glomerular filtration rates (inulin clearances) dur ing the 3rd and 4th wk of therapy in both prospective and double-blinded st udies. Vehicle had no effect. No patient required discontinuation of drug s econdary to side effects. We conclude that IGF-I effects sustained improvem ent of renal function (clearances comparable to those generally achieved by dialysis) in patients with ESRD and is well tolerated.