title: Growth hormone treatment in growth retarded children with end stage renal failure: effect on free/dissociable IGF-I levels.
abstract: Growth retardation in children with endstage renal disease (ESRD) is associated with normal to slightly low concentrations of insulin-like growth factor (IGF)-I and increased concentrations of IGF-binding proteins (IGFBPs) in serum. Consequently, IGF-I bioactivity is reduced in serum from uremic patients presumably due to a decrease in the concentration of free IGF-I. Improvement of linear growth with growth hormone (GH) treatment of uremic children is thought to be due to increased IGF-I/IGFBP ratio, thus resulting in increased free IGF-I levels during treatment. The purpose of the present study was to determine whether free/dissociable IGF-I levels are in fact low in uremic children and whether increased growth velocity during GH treatment is associated with an increase in the free IGF-I concentration. Serum total and free/dissociable IGF-I concentrations were measured in 5 children with ESRD before and during treatment with GH, and in control children matched for age, pubertal status, and body mass index. Height velocity increased from 3.7 +/- 1.0 cm/yr to 6.5 +/- 1.2 cm/yr with an increment in height SDS at the end of the first year of GH treatment. Free/dissociable IGF-I concentrations tended to be lower in uremic children compared to control children (3.0 +/- 0.3 vs 7.3 +/- 2.1 micrograms/l, respectively). During GH treatment, free/dissociable IGF-I levels increased significantly to 8.5 +/- 1.0 micrograms/l at 3 months and 6.9 +/- 1.4 micrograms/l at 6-24 months, p < 0.05 compared to pretreatment. Total IGF-I levels were 243 +/- 18 micrograms/l in children with ESRD before treatment and these values also increased during GH treatment (740 +/- 114 micrograms/l at 3 months and 442 +/- 44 micrograms/l at 6-24 months, p < 0.05, compared to pretreatment). Total IGF-I concentration in the control group was 439 +/- 114 micrograms/l. These results support the hypothesis that growth retardation in children with chronic renal failure is associated with a reduction in the concentration of free, biologically available IGF-I, and that increased growth velocity during GH treatment of these children is associated with restoration of free IGF-I concentrations.
authors.affiliation: Division of Pediatric Endocrinology, University Hospital, State University of New York at Stony Brook 11794-8111, USA.
authors.forename: A
authors.initials: A
authors.lastname: Bereket
authors.forename: C H
authors.initials: CH
authors.lastname: Lang
authors.forename: S L
authors.initials: SL
authors.lastname: Blethen
authors.forename: F J
authors.initials: FJ
authors.lastname: Kaskel
authors.forename: C
authors.initials: C
authors.lastname: Stewart
authors.forename: T A
authors.initials: TA
authors.lastname: Wilson
mesh_terms: D001827:Body Height; D015992:Body Mass Index; D002648:Child; D005260:Female; D006130:Growth Disorders / Q000188:drug therapy* / Q000209:etiology; D019382:Human Growth Hormone / Q000627:therapeutic use*; D006801:Humans; D018969:Insulin-Like Growth Factor Binding Proteins / Q000097:blood; D007334:Insulin-Like Growth Factor I / Q000378:metabolism*; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications*; D008297:Male
chemical_list: D018969:Insulin-Like Growth Factor Binding Proteins; D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I