title: Growth hormone for children with chronic kidney disease.
abstract: BACKGROUND
  Chronic kidney disease (CKD) is an uncommon but important condition. Growth retardation, one of the complications of CKD, is of concern to families. Recombinant human growth hormone (rhGH) treatment has been used to help short children with CKD attain a height more in keeping with their age group. However, there are concerns that rhGH may have an adverse effect on the preservation of native kidney function, predispose to acute rejection in kidney transplant recipients, and cause benign intracranial hypertension and slipped capital femoral epiphysis.
  
  
  OBJECTIVE
  To evaluate the benefits and harms of rhGH treatment in children with CKD.
  
  
  METHODS
  Randomised controlled trials (RCTs) were identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, article reference lists and through contact with local and international experts in the field. Date of most recent search: July 2005
  
  
  METHODS
  RCTs were included if they were carried out in children aged 0-18 years, diagnosed with CKD, who were pre-dialysis, on dialysis or post-transplant; if they compared rhGH treatment with placebo/no treatment or two doses of rhGH treatments; and if they included height outcomes.
  
  
  METHODS
  Two reviewers independently assessed studies for methodological quality and extracted data from eligible trials. Data was pooled using a random effects model with calculation of weighted mean difference (MD) for continuous outcomes and relative risk (RR) for categorical outcomes with 95% confidence intervals (CI).
  
  
  RESULTS
  Fifteen RCTs (629 children) were identified. Treatment with rhGH (28 IU/m(2)/wk) resulted in a significant increase in height standard deviation score (SDS) at one year (MD 0.78 SDS, 95% CI 0.52 to 1.04), and a significant increase in height velocity at six months (MD 2.85 cm/6 mo, 95%CI 2.22 to 3.48) and one year (MD 3.80 cm/y, 95%CI 3.20 to 4.39). Compared to the 14 IU/m(2)/wk group, there was a 1.34 cm/y (0.55 to 2.13) increase in height velocity in the 28 IU/m(2)/wk group. The frequency of reported side effects of rhGH were similar to that of the control group.
  
  
  CONCLUSIONS
  One year of 28 IU/m(2)/wk rhGH in children with CKD resulted in a 3.80 cm/y increase in height velocity above that of untreated patients. Trials were too short to determine if continuing treatment resulted in an increase in final adult height.
authors.forename: D
authors.initials: D
authors.lastname: Vimalachandra
authors.forename: E M
authors.initials: EM
authors.lastname: Hodson
authors.forename: N S
authors.initials: NS
authors.lastname: Willis
authors.forename: J C
authors.initials: JC
authors.lastname: Craig
authors.forename: C
authors.initials: C
authors.lastname: Cowell
authors.forename: J F
authors.initials: JF
authors.lastname: Knight
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006130:Growth Disorders / Q000188:drug therapy* / Q000209:etiology; D013006:Growth Hormone / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007676:Kidney Failure, Chronic / Q000150:complications*; D016032:Randomized Controlled Trials as Topic
chemical_list: D013006:Growth Hormone