Abitbol C, Zilleruello G, Strauss J, Montane B
Response to growth hormone related to dialysis efficiency in
dialyzed children
Am Soc Nephrol
J Am Soc Nephrol (abstract)
(Sep) 7:1505 1996
Poor growth is a major problem in children with chronic renal failure, and
pediatric nephrologists typically use a variety of measures to address
this, including control of acidosis, aggressive treatment of renal
osteodystrophy, specified enteral nutrition, and institution of dialysis.
Most recently, recombinant human growth hormone (rhGH) has been used in
this population with good results, although the growth is somewhat better
if rhGH can be used before the child requires dialysis.
In this study, Abitbol et al examined the relationship between the dose of
dialysis, nitrogen balance and the response to rhGH treatment in 11
growth-retarded children, 8 of whom were receiving HD and 3 who were
receiving PD. Dialysis efficiency was estimated by either calculating urea
clearance from the urea reduction ratio or by measuring urea in the
dialysis effluent. Nitrogen balance was also calculated for each patient as
the difference between dietary nitrogen intake and the calculated urea
nitrogen appearance.
The authors found that nitrogen balance in their patients correlated
positively with an increasing Kt/V, and that in 4 children who had their
heights followed for one year, the response to rhGH depended on the dose of
dialysis received; specifically, there was a poor response to rhGH unless
the Kt/V was 1.5 or greater. They conclude that improved dialysis
efficiency promotes positive nitrogen balance and that the response to rhGH
may depend on dialysis efficiency.
Comment: The most striking finding in this study is the relatively
inefficient dialysis received by these children: average Kt/V was
approximately 1.1. While there are no agreed-upon standards for the
"optimal" Kt/V to achieve in children on dialysis, this value appears to be
too low to promote normal growth. In addition, the authors should have
separated the HD and PD children into separate groups. Work by Kaiser et al
(Pediatric Nephrology 8:733, 1994) has shown that growth is superior
in children on PD compared to children on HD. A larger, probably
multicenter study is clearly needed to answer the questions raised by this
small study.
(Joseph Flynn, M.D., University of Michigan, Ann Arbor)
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Am Soc Nephrol
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