Obstacles to the prescribing of growth hormone in children with chronic kidney disease

Abstract

Despite its effectiveness, recombinant human growth hormone (rhGH) is under-utilized in short children with chronic kidney disease (CKD). We conducted a multicenter study to explore the obstacles preventing children with CKD from receiving rhGH. We investigated the use of rhGH in 307 children with CKD from seven pediatric nephrology centers. Among the 110 patients who fell below the 5th percentile, 56 (51%) had not received rhGH. The most common reasons given for these children not receiving rhGH were family refusal, secondary hyperparathyroidism, and non-compliance. However, no explanation was apparent for 25% of the short children with CKD. Boys were more likely than girls to receive rhGH (65% vs 31%; P = 0.002). Use of rhGH was similar in African Americans and non-Hispanic Whites. Children who had received rhGH achieved a 0.5 increase in height z-score in the first year after the initiation of rhGH therapy. Children who had not received rhGH achieved a 0.03 increase in height z-score during the first year after falling below the 5th percentile (P = 0.005 vs the children who had received rhGH). Waiting for insurance company approval led to a significant delay in the initiation of rhGH treatment in 18% of patients. The fact that more than 50% of short children with CKD did not receive rhGH is secondary to multiple factors, many of which may be amenable to intervention efforts.

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References

  1. 1.

    Mahan JD, Warady BA (2006) Assessment and treatment of short stature in pediatric patients with chronic kidney disease: a consensus statement. Pediatr Nephrol 21:917–930

    Article  Google Scholar 

  2. 2.

    Fine RN, Kohaut EC, Brown D, Perlman AJ (1994) Growth after recombinant human growth hormone treatment in children with chronic renal failure: report of a multicenter randomized double-blind placebo-controlled study. Genentech Cooperative Study Group. J Pediatr 124:374–382

    CAS  Article  Google Scholar 

  3. 3.

    Schaefer F, Wuhl E, Haffner D, Mehls O (1994) Stimulation of growth by recombinant human growth hormone in children undergoing peritoneal or hemodialysis treatment. German Study Group for Growth Hormone Treatment in Chronic Renal Failure. Adv Perit Dial 10:321–326

    CAS  PubMed  Google Scholar 

  4. 4.

    Berard E, Crosnier H, Six-Beneton A, Chevallier T, Cochat P, Broyer M (1998) Recombinant human growth hormone treatment of children on hemodialysis. French Society of Pediatric Nephrology. Pediatr Nephrol 12:304–310

    CAS  Article  Google Scholar 

  5. 5.

    Haffner D, Schaefer F, Nissel R, Wuhl E, Tonshoff B, Mehls O (2000) Effect of growth hormone treatment on the adult height of children with chronic renal failure. German Study Group for Growth Hormone Treatment in Chronic Renal Failure. N Engl J Med 343:923–930

    CAS  Article  Google Scholar 

  6. 6.

    Seikaly MG, Salhab N, Warady BA, Stablein D (2007) Use of rhGH in children with chronic kidney disease: lessons from NAPRTCS. Pediatr Nephrol 22:1195–1204

    Article  Google Scholar 

  7. 7.

    Schwartz GJ, Haycock GB, Edelmann CM Jr, Spitzer A (1976) A simple estimate of glomerular filtration rate in children derived from body length and plasma creatinine. Pediatrics 58:259–263

    CAS  Google Scholar 

  8. 8.

    Blethen SL, Baptista J, Kuntze J, Foley T, LaFranchi S, Johanson A (1997) Adult height in growth hormone (GH)-deficient children treated with biosynthetic GH. The Genentech Growth Study Group. J Clin Endocrinol Metab 82:418–420

    CAS  Article  Google Scholar 

  9. 9.

    Hindmarsh PC, Brook CG (1996) Final height of short normal children treated with growth hormone. Lancet 348:13–16

    CAS  Article  Google Scholar 

  10. 10.

    Leung W, Rose SR, Zhou Y, Hancock ML, Burstein S, Schriock EA, Lustig R, Danish RK, Evans WE, Hudson MM, Pui CH (2002) Outcomes of growth hormone replacement therapy in survivors of childhood acute lymphoblastic leukemia. J Clin Oncol 20:2959–2964

    CAS  Article  Google Scholar 

  11. 11.

    National Kidney Foundation (2005) K/DOQI clinical practice guidelines for bone metabolism and disease in children with chronic kidney disease. Am J Kidney Dis 46:S1–S122

    Google Scholar 

  12. 12.

    Maxwell H (1996) Recombinant human growth hormone (rhGH) treatment of infants and young children with chronic renal failure. Br J Clin Pract Suppl 85:64–65

    CAS  PubMed  Google Scholar 

  13. 13.

    Rogers PC, Komp D, Rogol A, Sabio H (1977) Possible effects of growth hormone on development of acute lymphoblastic leukaemia. Lancet 2:434–435

    CAS  Article  Google Scholar 

  14. 14.

    Allen DB, Rundle AC, Graves DA, Blethen SL (1997) Risk of leukemia in children treated with human growth hormone: review and reanalysis. J Pediatr 131:S32–S36

    CAS  Article  Google Scholar 

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Correspondence to Larry A. Greenbaum.

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Greenbaum, L.A., Hidalgo, G., Chand, D. et al. Obstacles to the prescribing of growth hormone in children with chronic kidney disease. Pediatr Nephrol 23, 1531–1535 (2008). https://doi.org/10.1007/s00467-008-0857-3

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Keywords

  • Growth hormone
  • Kidney diseases
  • Short stature
  • Secondary hyperparathyroidism
  • Children