The effect of recombinant human growth hormone treatment on bone and mineral metabolism in haemodialysis patients.
BACKGROUND
Uraemia and chronical haemodialysis are associated with an abnormal growth hormone (GH)-insulin-like growth factor (IGF) axis which may contribute to malnutrition and renal bone disease. Short-term studies have shown a beneficial effect of treatment with recombinant human growth hormone (rhGH) on nutritional status in patients on haemodialysis. In the present study, we evaluated the effect of rhGH on bone and mineral metabolism.


METHODS
Twenty chronic malnourished patients on haemodialysis took part in a double-blind, placebo controlled trial with subcutaneous injections of rhGH (4 IU/m2/day) or placebo for 6 months.


RESULTS
During rhGH treatment, serum IGF-1 increased 264 +/- 52% (mean +/- SEM) (P < 0.008). There were no significant changes in biochemical markers of mineral metabolism (serum ionized calcium, phosphate and parathyroid hormone). Among markers of bone metabolism, there was a significant increase in serum procollagen type I C-terminal propeptide (maximum 155 +/- 8%, P < 0.001) and no significant changes in serum alkaline phosphatase. Bone densitometry showed a significant decrease in whole body bone mineral content (95.7 +/- 1.2%) after 6 months treatment. The effects on the proximal femur were not significant.


CONCLUSIONS
The effects of 6 months treatment with rhGH seen in this study are best explained by a GH- or IGF-1-induced increased bone turnover. Long-term treatment in larger cohorts followed by bone densitometry and, preferentially, bone histomorphometry are needed to evaluate whether this is a beneficial effect in haemodialysis patients.
Gram
J
J
Department of Endocrinology, Odense University Hospital, Denmark. jeppe.gram@dadlnet.dk
Hansen
T B
TB
Jensen
P B
PB
Christensen
J H
JH
Ladefoged
S
S
Pedersen
F B
FB
D000293:Adolescent; D000328:Adult; D000368:Aged; D015519:Bone Density / Q000187:drug effects; D001842:Bone and Bones / Q000187:drug effects* / Q000378:metabolism*; D004311:Double-Blind Method; D005260:Female; D019382:Human Growth Hormone / Q000627:therapeutic use*; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D008903:Minerals / Q000378:metabolism*; D009748:Nutrition Disorders / Q000188:drug therapy / Q000209:etiology / Q000378:metabolism; D009752:Nutritional Status; D006435:Renal Dialysis / Q000009:adverse effects
D008903:Minerals; D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I