Growth and Growth Hormone Therapy in Children with CKD ADC 2016

70 Pages·2016·3.94 MB·English

Growth and Growth Hormone
Therapy in Children with CKD
ADC 2016
John D Mahan, MD
Professor of Pediatrics
Nationwide Children’s/the Ohio State University
College of Medicine
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Overview
Background
•Growth in Patients with CKD
•Causes of Growth Failure in CKD
Growth Assessment and Evaluation for
Growth Hormone Treatment in Children
with CKD
Growth Hormone Therapy in Children with
CKD: Benefits, Risks
Guidelines for Evaluating the Growth
Response to rhGH Therapy
Growth: the Paramount Concern!
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2
1. Growth is one of the MOST
important issues that children with
CKD confront!
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What Concerns Children and Parents About
Living with CKD*?
Reynolds JM Arch Dis Child.
1995;73:36-42.
Percent (%)
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Social Outcome Following Renal Transplantation
is Greatly Influenced by Adult Height
Adult height was significantly correlated with:
Characteristic P value
Year of transplantation .04
Higher educational level achieved <.001
Higher rate of paid employment .02
Greater likelihood of marriage <.0001
Greater likelihood of independent living .0003
Broyer M, Transplantation 2004: 77:1033-1037.
Height Dissatisfaction - Impacts Quality of Life
40
Mean adult height SDS score:
35
–1.56 ± 1.55

t
h
g 30 Height satisfaction correlated
i
se
lh
a
ut significantly with height SDS
dul 25
vid
ia score (r = 0.42; P = .006)
d
nh
f iwit 20
o Quality of life correlated
d
t
ne
cesfi 15 significantly with height
ri
eat
Ps satisfaction
s 10
i
d
(r = 0.41; P = .008)
5
0
Adults with Healthy
childhood- age-matched
onset ESRD controls
Rosenkranz J, Pediatr Nephrol 2005;20:1288-1294.
Growth Patterns in Patients with CKD
Height
Child Without CKD
Child With CKD
Birth Puberty
Adapted from Betts et al. Br Med J. 1974;2:189-193.
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Growth in Patients with CKD
Patient 1 Patient 2
8
Growth Failure in Children with CKD is
Associated with Poorer Survival
Height in 2,306 patients with CKD – NAPRTCS
At initiation of dialysis - 1992-2001
100
Age >1, Z > -2.5
90

) Age > 1, Z<-2.5
%80
( Age 0-1, Z > -2.5

l
a
70
v
i
v
r
Age 0-1, Z < -2.5
u60
S
50

40

30
0 1 2 3
Years
Furth S, Pediatrics 2002
Growth Failure in Children on Dialysis is
Associated with Poorer Survival
1,112 patients < 18 yo ESRD – USRDS
Tanner Stage I to IV, ht data Jan-Dec 1990
100

Normal growth
) 95
%

(

l 90
a
v
i
v
r 85 Moderate growth failure
u

S
80
Severe growth failure
75

0 250 500 750 1000 1250 1500 1750 2000
Days
Furth S.. Pediatr Nephrol 2002