title: The skeletal consequences of growth hormone therapy in dialyzed children: a randomized trial.
abstract: OBJECTIVE
  The effects of recombinant human growth hormone on renal osteodystrophy are unknown; thus, the effects of growth hormone (GH) on bone histomorphometry were assessed in pediatric patients with ESRD.
  
  
  METHODS
  Thirty-three patients who underwent bone biopsy between July 1994 and May 1999 were randomly assigned to therapy with or without GH. Patients were stratified by bone formation rate; all patients with high bone turnover received intraperitoneal calcitriol. Serum biochemical values were obtained monthly, and bone biopsy was repeated after 8 months.
  
  
  RESULTS
  Median patient age was 11.7 years (interquartile range [IQR], 7.6, 14.1 years); 45% of patients were male, and 52% were prepubertal. Median dialysis duration was 0.4 (IQR, 0.3, 0.8) year. Bone formation rate per bone surface increased from 15.0 (9.6, 21.8) to 154.6 (23.7, 174.3) μm(2)/μm(3) per year (P=0.05) in patients with low bone turnover treated with GH, decreased from 103.3 (57.0, 173.4) to 60.3 (20.3, 13.7) μm(2)/μm(3) per year in patients with high bone turnover receiving standard therapy (P=0.03), and was unchanged in the other two groups. Bone formation rates were higher with GH, irrespective of underlying bone histologic features (P=0.05). Parathyroid hormone did not differ between groups. GH therapy resulted in greater increases in height SD scores (estimated mean difference in change ± SD, 0.324±0.076; P<0.001), irrespective of underlying bone histologic features.
  
  
  CONCLUSIONS
  GH therapy improves height in pediatric dialysis patients, irrespective of underlying bone histologic features. Bone formation rates are higher in GH recipients, and GH therapy alters the relationship between circulating parathyroid hormone values and bone turnover.
authors.affiliation: Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California 90095, USA.
authors.forename: Justine
authors.initials: J
authors.lastname: Bacchetta
authors.forename: Katherine
authors.initials: K
authors.lastname: Wesseling-Perry
authors.forename: Beatriz
authors.initials: B
authors.lastname: Kuizon
authors.forename: Renata C
authors.initials: RC
authors.lastname: Pereira
authors.forename: Barbara
authors.initials: B
authors.lastname: Gales
authors.forename: He-jing
authors.initials: HJ
authors.lastname: Wang
authors.forename: Robert
authors.initials: R
authors.lastname: Elashoff
authors.forename: Isidro B
authors.initials: IB
authors.lastname: Salusky
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D001827:Body Height / Q000187:drug effects; D001842:Bone and Bones / Q000187:drug effects* / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D012080:Chronic Kidney Disease-Mineral and Bone Disorder / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D019382:Human Growth Hormone / Q000627:therapeutic use*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D015141:Los Angeles; D008297:Male; D010012:Osteogenesis / Q000187:drug effects; D010281:Parathyroid Hormone / Q000097:blood; D010530:Peritoneal Dialysis; D011994:Recombinant Proteins / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015415:Biomarkers; C470125:PTH protein, human; D010281:Parathyroid Hormone; D011994:Recombinant Proteins; D019382:Human Growth Hormone
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