rhGH Therapy in Chronic Kidney Diseases

In children with chronic kidney disease (CKD), growth retardation is not a rare problem. Factors such as malnutrition, anemia, metabolic acidosis, inadequate dialysis and growth hormone resistance may cause growth failure in these children. Growth stimulation in these children can be done by supraphysiologic doses of recombinant human GH (rhGH). It stimulates growth in prepubertal CKD children, in end-stage renal disease, and after kidney transplantation. Its underlying mechanism may be the reversal of hypercatabolic state of uremia or increases in the circulating level of insulin-like growth factor (IGF). We recommend starting the treatment when the patient height falls below the third percentile and spontaneous catch-up growth does not happen despite stabilization of other contributing factors. It is better to start rhGH therapy at a young age because there is a better response in preterminal CKD than those on dialysis. We use rhGH in CKD children at a dose of 0.045 to 0.05 mg/kg/day subcutaneously every evening and a height taller than the third percentile of the general population is our minimal goal.