Growth hormone and malnutrition in dialysis patients.
OBJECTIVE
To review the normal function of the growth hormone (GH) insulin-like growth factor (IGF) axis, how it is altered in end-stage renal failure, how this may contribute to malnutrition in dialysis patients, and how therapy with recombinant human growth hormone (rHuGH) and recombinant human IGF-I (rHuIGF-1) might be used to treat malnutrition in these patients.


METHODS
Studies in the literature dealing with the GH-IGF endocrine axis and its role in uremic malnutrition.


METHODS
Eight studies in which uremic adults were treated with either rHuGH or rHuIGF-I.


METHODS
Data were abstracted from all of these studies.


RESULTS
The review shows that there are marked abnormalities of the GH-IGF axis in uremic patients and that these lead to a state of GH resistance, which can be overcome by pharmacological doses of rHuGH. A small number of clinical studies in uremic adults suggests that both rHuGH and rHuIGF-I have dramatic beneficial effects on nutritional status in these patients.


CONCLUSIONS
rHuGH and rHuIGF-I have both been shown to have a beneficial effect on nutritional status in short-term studies on small numbers of patients. Further studies need to be done for longer periods in larger groups of patients. Areas for additional research are suggested.
Blake
P G
PG
Victoria Hospital, London, Ontario, Canada.
D000328:Adult; D002648:Child; D004351:Drug Resistance; D013006:Growth Hormone / Q000502:physiology* / Q000627:therapeutic use; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000502:physiology* / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D009748:Nutrition Disorders / Q000188:drug therapy / Q000209:etiology*; D009752:Nutritional Status; D010531:Peritoneal Dialysis, Continuous Ambulatory; D011994:Recombinant Proteins; D014511:Uremia / Q000150:complications / Q000503:physiopathology / Q000628:therapy
D011994:Recombinant Proteins; D007334:Insulin-Like Growth Factor I; D013006:Growth Hormone