Obstacles to the prescribing of growth hormone in children with chronic kidney disease.
Despite its effectiveness, recombinant human growth hormone (rhGH) is under-utilized in short children with chronic kidney disease (CKD). We conducted a multicenter study to explore the obstacles preventing children with CKD from receiving rhGH. We investigated the use of rhGH in 307 children with CKD from seven pediatric nephrology centers. Among the 110 patients who fell below the 5th percentile, 56 (51%) had not received rhGH. The most common reasons given for these children not receiving rhGH were family refusal, secondary hyperparathyroidism, and non-compliance. However, no explanation was apparent for 25% of the short children with CKD. Boys were more likely than girls to receive rhGH (65% vs 31%; P = 0.002). Use of rhGH was similar in African Americans and non-Hispanic Whites. Children who had received rhGH achieved a 0.5 increase in height z-score in the first year after the initiation of rhGH therapy. Children who had not received rhGH achieved a 0.03 increase in height z-score during the first year after falling below the 5th percentile (P = 0.005 vs the children who had received rhGH). Waiting for insurance company approval led to a significant delay in the initiation of rhGH treatment in 18% of patients. The fact that more than 50% of short children with CKD did not receive rhGH is secondary to multiple factors, many of which may be amenable to intervention efforts.
Department of Pediatrics, Division of Pediatric Nephrology, Emory University and Children's Healthcare of Atlanta, 2015 Uppergate Drive, NE, Atlanta, GA, 30322, USA. Larry_Greenbaum@oz.ped.emory.edu
Larry A
LA
Greenbaum
Guillermo
G
Hidalgo
Deepa
D
Chand
Myra
M
Chiang
Katherine
K
Dell
Theresa
T
Kump
Lena
L
Peschansky
Holly K
HK
Smith
Mary
M
Boyle
Michelle
M
Kopf
Lisa C
LC
Metz
Margaret
M
Kamel
John D
JD
Mahan
D000293:Adolescent; D001827:Body Height; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D005260:Female; D006130:Growth Disorders / Q000188:drug therapy*; D019382:Human Growth Hormone / Q000627:therapeutic use*; D006801:Humans; D007674:Kidney Diseases / Q000150:complications*; D008297:Male
D019382:Human Growth Hormone