Potential role of growth factors with particular focus on growth hormone and insulin-like growth factor-1 in the management of chronic kidney disease.
Prevention and treatment of chronic kidney disease (CKD) so far primarily has been based on early and aggressive treatment of hypertension. A number of other therapeutic approaches have the potential of being translated to the clinical area within the foreseeable future. In this review, we focus on growth factors and, in particular, on the role of growth hormone (GH) and insulin-like growth factor-1 (IGF-1) in the treatment of CKD and the management of its complications. Disturbances of the GH-IGF-1 axis in CKD have suggested therapeutic roles for both the inhibition, as well as the stimulation, of that axis in CKD. Experimental data have suggested that GH may have a detrimental effect on kidney growth, scarring, and the progression of CKD. Therapies based on the inhibition of GH showed some benefit, but failed to translate to clinical CKD. On the other hand, the administration of IGF-1 has been reported in a number of small studies to have conflicting effects on renal function. In end-stage renal disease, GH has been shown in a number of small-scale studies to modify inflammation, improve lipid profile, and favorably affect cardiovascular parameters. Studies also have shown some benefit of IGF-1 administration on the nutritional parameters of patients on renal replacement therapy. More recently, a larger randomized, double-blind, placebo-controlled, 26-week, proof-of-concept clinical study was conducted to investigate the effect of GH (Norditropin; Novo Nordisk, Bagsvaerd, Denmark) in adult chronic hemodialysis (CHD) patients. Beneficial effects were observed on lean body mass, serum albumin, high-density lipoprotein cholesterol, and homocysteine levels, all known to be associated with mortality and morbidity in CHD. These studies suggested that GH therapy may prove beneficial in reducing morbidity and mortality in CHD patients.
Feldt-Rasmussen
Bo
B
Department of Nephrology, Rigshospitalet, University of Copenhagen, Denmark. bfr@rh.dk
El Nahas
Meguid
M
D045930:Anabolic Agents / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D013006:Growth Hormone / Q000502:physiology / Q000627:therapeutic use*; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000502:physiology / Q000627:therapeutic use*; D007676:Kidney Failure, Chronic / Q000188:drug therapy* / Q000503:physiopathology; D011502:Protein-Energy Malnutrition / Q000188:drug therapy* / Q000503:physiopathology
D045930:Anabolic Agents; D007334:Insulin-Like Growth Factor I; D013006:Growth Hormone