Twenty-five years of growth hormone treatment in non-dialyzed children with chronic kidney disease in Poland – efficacy, safety, metabolic effects, and factors influencing response

Introduction
Recombinant human growth hormone (rhGH) treatment has been a well-established means of dealing with chronic kidney disease (CKD)-related short-stature for over 25 years. The aim of this study was to evaluate the safety, efficacy, metabolic effects, and factors influencing response to rhGH treatment in Poland.

Material and methods
156 non-dialyzed children with different stages of CKD were analysed regarding anthropometric features, biochemical parameters, calcium-phosphorus metabolism, bone mineral density (BMD), and CKD progression. The analysis comprised 24 months of treatment.

Results
The median height velocity during the whole course of treatment in the analysed group was 8 cm/year. In the first year of treatment, it was significantly faster than in the second year (9.5 cm/year and 7.6 cm/year, respectively, p < 0.01) and did not differ between children with CKD stage 2–3 (group A) and with CKD stage 4–5 (group B). Age of therapy onset correlated negatively with total ΔheightSDS (r = –0.21, p < 0.05). Throughout the treatment we observed a decrease of hypercalcemia (both groups) and an increase of hyperphosphatemia (group A). In the first year parathyroid hormone (PTH), IGF-1, CaxP, and ALP increased. In the second year PTH, IGF-1, and CaxP stabilized, and ALP decreased. ΔheightSDS correlated negatively with initial and mean serum cholesterol. Serum triglyceride concentration increased in the course of treatment. After 24 months, total body BMD increased in group A, and lumbar spine BMD increased in both groups (A and B). The mean decrease of glomerular filtration rate was 2.5 ml/min/1.73 m2/year.

Conclusions
rhGH treatment is safe and effective, and should include the youngest CKD patients. Our results suggest that there might be a relationship between rhGH treatment and lipid profile, which necessitates further research.