HDCN Article Review/Hyperlink

Ikizler TA, WIngard RL, Flakoll PJ, Schulman G, Parker RA, Hakim RM

Effects of recombinant human growth hormone on plasma and dialysate amino acid profiles in CAPD patients

Kidney Int (Jul) 50:229-234 1996

This study is a further analysis of an already published piece of work by this group which involved a prospective cross-over study on the nutritional effects of a one week course of recombinant human growth hormone [rhGH] in ten CAPD patients. The initial study showed a dramatically beneficial effect on nitrogen balance as well as falls in serum potassium suggesting a net anabolic action. Surprisingly, however, there was a small fall in serum albumin during the study. In this follow-up analysis, the investigators look at the changes induced by rhGH in plasma and dialysate amino acid profiles. In essence they show that there were significant decreases in essential amino acid levels in both plasma and dialysate whereas there were significant increases in non-essential amino acid levels. These changes quickly reversed after the discontinuation of the rhGH. The alterations in plasma amino acids are similar to those to be shown by other investigators in normal volunteers and in surgical patients. They were interpreted as meaning that the patients in the study became anabolic during the rhGH treatment with the falls in levels of essential amino acids suggesting that these were being retained in muscle in order to synthesize protein. They speculate that the increase in non-essential amino acid levels could be due to increased absorption from the gut as has been suggested by other investigators. They also speculate that the fall in serum albumin seen in their patients might have represented a shift in essential amino acids away from visceral to somatic protein synthesis.

Comment: One weakness of the study which the authors admit is that they were not carried out in a supervised setting so that major dietary variations could not be excluded. Nevertheless, the results are consistent with ongoing findings that rhGH can induce a profoundly anabolic state in dialysis patients. This agent merits further investigation in longer term studies and especially in more malnourished dialysis patients. (Peter G. Blake, M.D., Victoria Hospital, London, Ontario)