Varying Use of Growth Hormone for Children with CKD

Pediatric nephrology centers vary in their use of growth hormone therapy for children with chronic kidney disease (CKD) and short stature, reports a study in BMC Nephrology.

The authors report an online survey distributed to US pediatric nephrologists, via the Midwest Pediatric Nephrology Consortium and the American Society of Pediatric Nephrology. Respondents were asked about their approach to recombinant human growth hormone (rhGH) therapy in short children with CKD. The analysis included 73 responses, 30 from small (4 or fewer pediatric nephrologists) and 43 from large practices. One-third of physicians and more than half of centers responded to the survey.

The initial workup for rhGH therapy varied considerably: 95% of pediatric nephrologists routinely obtained bone age, but only 40% obtained hip and knee x-rays. The workup included thyroid function assessment for 58% of respondents, insulin-like growth factor-1 measurement for 40%, and ophthalmologic evaluation for 7%.

Just over half (52%) of respondents said they rarely involve endocrinologists in managing rhGH therapy. However, more than one-fourth (27%) said that endocrinologists managed most aspects of rhGH therapy. While 68.5% of centers had a dedicated renal dietitian, 21% reported that the nephrologist was the main resource for nutritional support.

At both large and small centers, family refusal was the most common reason why children with growth failure did not receive rhGH. Ninety-five percent of pediatric nephrologists believed rhGH improved quality of life, 44% that it improved lean body mass, and 24% that it improved physical function.

Use of rhGH in children with CKD and short stature is thought to be low. Decision-making about growth hormone therapy is complicated by a lack of high-quality evidence.

This study shows significant variability concerning the use of rhGH for children with CKD at US pediatric nephrology centers. The researchers write, “Our data suggests that opportunities are available to standardize care to improve growth outcomes in children with CKD” [Akchurin OM, et al. Approach to growth hormone therapy in children with chronic kidney disease varies across North America: the Midwest Pediatric Nephrology Consortium report. BMC Nephrol 2017; doi: 10.1186/s12882-017-0599-1].

July 2017 (Vol. 9, Number 6)