There is some evidence that human growth hormone may help reduce growth problems in children with chronic kidney disease

Vimalachandra D, Hodson EM, Willis NS, Craig JC, Cowell CT, Knight JF

Published Online:

April 14, 2010

The kidneys filter blood. Children with chronic kidney disease (CKD) may progress to end-stage kidney failure and need their blood filtered by machine (dialysis) or need a kidney transplant. CKD can stunt growth in children. Growth hormone (rhGH) has been used to help children grow to a more average height for their age but rhGH may have adverse effects including added risk of transplant rejection and high pressure in the brain. The review of trials found that rhGH increased height in children with CKD by about 4 cm to 6 cm with 1-2 years of treatment and that adverse effects are very rare.

Abstract (click to read)

Background:

Chronic kidney disease (CKD) is an uncommon but important condition. Growth retardation, one of the complications of CKD, is of concern to families. Recombinant human growth hormone (rhGH) treatment has been used to help short children with CKD attain a height more in keeping with their age group. However, there are concerns that rhGH may have an adverse effect on the preservation of native kidney function, predispose to acute rejection in kidney transplant recipients, and cause benign intracranial hypertension and slipped capital femoral epiphysis.

Objectives:

To evaluate the benefits and harms of rhGH treatment in children with CKD.

Search strategy:

Randomised controlled trials (RCTs) were identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, article reference lists and through contact with local and international experts in the field.

Selection criteria:

RCTs were included if they were carried out in children aged 0-18 years, diagnosed with CKD, who were pre-dialysis, on dialysis or post-transplant; if they compared rhGH treatment with placebo/no treatment or two doses of rhGH treatments; and if they included height outcomes.

Data collection and analysis:

Two reviewers independently assessed studies for methodological quality and extracted data from eligible trials. Data was pooled using a random effects model with calculation of mean difference (MD) for continuous outcomes and risk ratio (RR) for categorical outcomes with 95% confidence intervals (CI).

Main results:

Fifteen RCTs (629 children) were identified. Treatment with rhGH (28 IU/m²/wk) resulted in a significant increase in height standard deviation score (SDS) at one year (MD 0.78 SDS, 95% CI 0.52 to 1.04), and a significant increase in height velocity at six months (MD 2.85 cm/6 mo, 95%CI 2.22 to 3.48) and one year (MD 3.80 cm/y, 95%CI 3.20 to 4.39). Compared to the 14 IU/m²/wk group, there was a 1.34 cm/y (0.55 to 2.13) increase in height velocity in the 28 IU/m²/wk group. The frequency of reported side effects of rhGH were similar to that of the control group.

Authors' conclusions:

One year of 28 IU/m²/wk rhGH in children with CKD resulted in a 3.80 cm/y increase in height velocity above that of untreated patients. Trials were too short to determine if continuing treatment resulted in an increase in final adult height.

This record should be cited as:

Vimalachandra D, Hodson EM, Willis NS, Craig JC, Cowell CT, Knight JF. Growth hormone for children with chronic kidney disease. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD003264. DOI: 10.1002/14651858.CD003264.pub2

Assessed as up to date:

May 22, 2006

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Primary Review Group:

Renal Group

Health topics:

Kidney disease > Chronic kidney disease > Endocrine (other)

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

There is some evidence that human growth hormone may help reduce growth problems in children with chronic kidney disease

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