Insulin-like growth factor I improves renal function in patients with end-stage chronic renal failure.
There is no pharmacological treatment to increase the glomerular filtration rate in end-stage renal disease (ESRD). The administration of 100 microgram/kg of insulin-like growth factor (IGF) I twice a day to patients with ESRD increases inulin clearance. However, its effect is short-lived and IGF-I has major side effects when given this way. To assess whether the use of a lower intermittent dose of IGF-I would effect sustained improved function with tolerable side effects we performed 1) a prospective open-labeled 24-day trial in which we enrolled five patients and 2) a 31-day randomized, double-blinded, placebo-controlled trial in which we enrolled 10 patients. Patients with ESRD [creatinine clearance of <15 ml. min-1. (1.73 m2)-1] and scheduled to initiate renal replacement therapy received subcutaneous IGF-I, 50 microgram. kg-1. day-1, or vehicle. Treatment with IGF I resulted in significantly increased glomerular filtration rates (inulin clearances) during the 3rd and 4th wk of therapy in both prospective and double-blinded studies. Vehicle had no effect. No patient required discontinuation of drug secondary to side effects. We conclude that IGF-I effects sustained improvement of renal function (clearances comparable to those generally achieved by dialysis) in patients with ESRD and is well tolerated.
Vijayan
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A
George M. O'Brien Kidney and Urologic Diseases Center, Renal Division, Department of Internal Medicine and Cell Biology and Physiology, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
Franklin
S C
SC
Behrend
T
T
Hammerman
M R
MR
Miller
S B
SB
D000368:Aged; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D018971:Insulin-Like Growth Factor Binding Protein 2 / Q000097:blood; D007334:Insulin-Like Growth Factor I / Q000009:adverse effects / Q000627:therapeutic use*; D007444:Inulin / Q000378:metabolism; D007668:Kidney / Q000187:drug effects* / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011994:Recombinant Proteins; D016896:Treatment Outcome
D018971:Insulin-Like Growth Factor Binding Protein 2; D011994:Recombinant Proteins; D007334:Insulin-Like Growth Factor I; D007444:Inulin