How are growth complications managed in children with chronic kidney disease (CKD)?

Updated: Jul 21, 2020
  • Author: Sanjeev Gulati, MD, MBBS, DNB(Peds), DM, DNB(Neph), FIPN(Australia), FICN, FRCPC(Canada); Chief Editor: Craig B Langman, MD  more...
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Answer

Disruption of the hypothalamic-pituitary growth hormone axis contributes to the growth hormone–resistant state in uremia. Long-term growth hormone treatment in children with chronic kidney disease (CKD) induces catch-up growth, and most patients may achieve normal adult height if treatment is initiated before end-stage renal disease (ESRD). [27] A Cochrane review of 16 studies yielded similar results finding that recombinant human growth hormone (rhGH) increased height in children with CKD by about 4 cm after 1 year and by an additional 2 cm after 2 years of treatment compared with no treatment. [28]

In children who have received a kidney transplant and fulfil the above growth criteria, we recommend initiation of growth hormone (GH) therapy 1 year after transplantation if spontaneous catch-up growth does not occur and steroid-free immunosuppression is not a feasible option. GH should be given at dosages of 0.045-0.05 mg/kg per day by daily subcutaneous injections until patients have reached their final height or until renal transplantation. [29]

Based on the Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines, treatment with rhGH should be considered under the following conditions [4, 15, 29] :

  • Children whose height for chronologic age varies by more than 2 negative standard deviation scores (SDS)

  • Children whose height velocity for chronologic age varies by more than 2 negative SDS

  • Children with growth potential documented by open epiphyses

  • No other contraindication for recombinant hGH use

Additionally, the following nutritional and metabolic imbalances should be corrected before use of recombinant hGH:

  • Insufficient intake of energy, protein, and other nutrients

  • Acidosis

  • Hyperphosphatemia (correct serum phosphorus level to < 1.5 times the upper limit for age)

  • Secondary hyperparathyroidism


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