Short-term growth hormone treatment and microcirculation: effects in patients with chronic kidney disease.
Endothelial dysfunction is common in patients with chronic kidney disease (CKD) and contributes significantly to the high long-term cardiovascular morbidity and mortality. The short-term cardiovascular effects of recombinant human growth hormone (rhGH) in CKD patients (stages III-V) and healthy controls (n=15 each) were explored in a single-center, non-randomized pilot study. Subjects were investigated before, after a 7 day treatment with rhGH, and after a 7 day wash-out period. Microcirculation was assessed by nailfold capillaroscopy and leg strain gauge plethysmography. Echocardiography was performed and serum concentrations of IGF-I and IGF-binding protein-3 (IGFBP-3) were determined. Before the start of rhGH therapy, mean post-ischemic maximum flow velocity of erythrocytes (V(RBC)) and leg blood flow (LBF) in CKD patients were significantly reduced to 68% and 75% of that seen in controls, whereas V(RBC) and LBF under resting conditions were comparable. Treatment with rhGH significantly increased V(RBC) and LBF under resting conditions. Whereas maximum post-ischemic V(RBC) was improved by rhGH in patients and controls, maximum post-ischemic LBF increased in controls only. This was paralleled by a non-significant reduction of total vascular resistance, and increased heart rate and cardiac index. In conclusion, CKD patients respond to short-term rhGH treatment with significantly improved capillary blood flow, whereas only minor effects on total peripheral resistance and cardiac output were noted.
Nissel
Richard
R
Department of Pediatrics, University Children's Hospital, Rembrandtstrasse 16/17, 18057 Rostock, Germany.
Fischer
Dagmar-Christiane
DC
Puhlmann
Andreas
A
Holdt-Lehmann
Birgit
B
Mitzner
Andrea
A
Petzsch
Michael
M
Körber
Thomas
T
Tiess
Michael
M
Schmidt
Reinhard
R
Haffner
Dieter
D
D000328:Adult; D015992:Body Mass Index; D016022:Case-Control Studies; D004452:Echocardiography; D005260:Female; D019382:Human Growth Hormone / Q000008:administration & dosage / Q000097:blood*; D006801:Humans; D018972:Insulin-Like Growth Factor Binding Protein 3 / Q000097:blood; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D007676:Kidney Failure, Chronic / Q000097:blood / Q000503:physiopathology* / Q000628:therapy*; D008297:Male; D008833:Microcirculation / Q000187:drug effects*; D018715:Microscopy, Video; D008875:Middle Aged; D010865:Pilot Projects; D010991:Plethysmography; D011994:Recombinant Proteins / Q000627:therapeutic use; D012039:Regional Blood Flow; D016896:Treatment Outcome
D018972:Insulin-Like Growth Factor Binding Protein 3; D011994:Recombinant Proteins; D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I