Vitamin D metabolite requirements in dialysed children receiving recombinant human growth hormone.
BACKGROUND
The aim of the study was to assess the requirement of active vitamin D in dialysed children during treatment with recombinant human growth hormone (rhGH).


METHODS
Twenty-six children (aged 5-15 years) were treated with rhGH for 6 months. The serum concentration of parathyroid hormone (PTH), alkaline phosphatase (AP), and calcium and phosphorus were measured in two groups of patients studied in the years 1994-1995 (group I) and 1995-1998 (group II) respectively. Group I received a constant dose of alfacalcidol that was sufficient to keep PTH below 200 pg/ml before rhGH treatment began. The serum PTH level was checked every 3 months. Alfacalcidol was administered to group II according to serum PTH levels checked on a monthly basis.


RESULTS
In group I the PTH level increased after 3 and 6 months of rhGH treatment from mean level 73+/-60; 155+/-156 and 344+/-249 pg/ml respectively; P<0.05. AP activity increased after 6 months of treatment from 206+/-99 to 325+/-124 U/l respectively; P<0.01. The calcium level decreased from baseline after 3 months of treatment from 2.36+/-0.21 to 2.17+/-0.12 mmol/l respectively; P<0.05. In group II AP activity increased after 3 and 6 months of treatment from 272+/-169 to 332+/-192 and 404. 9+/-219.8 U/l respectively; P<0.01. The mean level of phosphorus decreased after 6 months from 2.15+/-0.28 to 1.70+/-0.39 mmol/l respectively; P<0.01. In group II the mean dose of alfacalcidol increased by 60.9%.


CONCLUSIONS
In children with end-stage renal failure, higher doses of vitamin D are needed during rhGH treatment. During rhGH treatment, frequent control of serum PTH level is necessary.
Pańczyk-Tomaszewska
M
M
Department of Paediatrics and Nephrology, Warsaw University Medical School, Warsaw, Poland.
Ziółkowska
H
H
Debiński
A
A
Sieniawska
M
M
D000293:Adolescent; D000469:Alkaline Phosphatase / Q000097:blood; D002118:Calcium / Q000097:blood; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D019382:Human Growth Hormone / Q000627:therapeutic use*; D006801:Humans; D006887:Hydroxycholecalciferols / Q000008:administration & dosage / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000097:blood / Q000188:drug therapy / Q000378:metabolism* / Q000628:therapy*; D010281:Parathyroid Hormone / Q000097:blood; D010531:Peritoneal Dialysis, Continuous Ambulatory; D010758:Phosphorus / Q000097:blood; D011994:Recombinant Proteins / Q000627:therapeutic use; D006435:Renal Dialysis; D014807:Vitamin D / Q000378:metabolism*
D006887:Hydroxycholecalciferols; D010281:Parathyroid Hormone; D011994:Recombinant Proteins; D019382:Human Growth Hormone; D014807:Vitamin D; D010758:Phosphorus; D000469:Alkaline Phosphatase; D002118:Calcium; C008088:alfacalcidol