Differential effects of short-term growth hormone therapy on the cardiovascular risk profile in patients with chronic kidney disease: a pilot study.
Chronic kidney disease (CKD) is highly associated with an increased cardiovascular morbidity and mortality and is also a state of growth hormone (GH) resistance. We examined the impact of a short-term treatment with rhGH on circulating markers of cardiovascular risk in nonmalnourished CKD patients in a single-center, nonrandomized pilot study. Patients with stable CKD Stage 3 - 5 and age- and sex-matched healthy controls (n = 15 each) received a 7-day treatment with rhGH (1.33 mg/m2 body surface area per day, approximately 30 microg/kg). Prior to onset of rhGH therapy, at the end of the treatment period and at the end of a 7-day wash-out period blood was drawn to assess changes in circulating markers of cardiovascular risk. At time of enrollment CKD patients showed elevated serum concentrations of phosphate, calcium x phosphate product, PTH, fibroblast growth factor-23 (FGF-23), triglycerides, leptin and homocysteine compared to controls. In patients and controls rhGH treatment induced an increase in circulating insulin-like growth factor I (IGF-I), and the molar ratio of IGF-I/IGF binding protein 3 as well as an elevation of glucose, insulin, and triglycerides, whereas serum urea was decreased. In CKD patients, rhGH treatment raised concentrations of leptin, whereas LDL-cholesterol, homocysteine, phosphate, and 25-hydroxyvitamin D were significantly reduced. In controls, but not in CKD patients, rhGH raised 1,25-dihydroxy-vitamin D3 serum levels, which were even more elevated at the end of the wash-out period. In conclusion, short-term treatment with rhGH in CKD patients affects not only insulin and glucose metabolism but also affects serum lipid profile, i.e., LDL-cholesterol, leptin and homocysteine. Long-term trials are required to evaluate the impact of rhGH on cardiovascular morbidity and mortality.
Fischer
D-C
DC
Department of Pediatrics, University Children's Hospital Rostock, Rostock, Germany. dagmar-christiane.fischer@med.uni-rostock.de
Nissel
R
R
Puhlmann
A
A
Mitzner
A
A
Tiess
M
M
Schmidt
R
R
Haffner
D
D
D000293:Adolescent; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D002318:Cardiovascular Diseases / Q000097:blood; D005260:Female; D000089703:Fibroblast Growth Factor-23; D005346:Fibroblast Growth Factors / Q000097:blood; D019382:Human Growth Hormone / Q000008:administration & dosage*; D006801:Humans; D018972:Insulin-Like Growth Factor Binding Protein 3 / Q000097:blood; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications* / Q000628:therapy; D008055:Lipids / Q000097:blood; D008297:Male; D044342:Malnutrition / Q000097:blood* / Q000188:drug therapy / Q000209:etiology; D008875:Middle Aged; D012307:Risk Factors; D055815:Young Adult
D001786:Blood Glucose; C000717427:FGF23 protein, human; D018972:Insulin-Like Growth Factor Binding Protein 3; D008055:Lipids; D019382:Human Growth Hormone; D005346:Fibroblast Growth Factors; D007334:Insulin-Like Growth Factor I; D000089703:Fibroblast Growth Factor-23