GH therapy for short stature safe for long-term renal function
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Young adults born small for gestational age treated with long-term growth hormone therapy had stable renal function in the 5 years after stopping treatment, with an estimated glomerular filtration rate comparable to healthy controls and young adults with short stature who did not receive GH, according to findings published in Clinical Endocrinology.
“GH treatment increases GFR, as higher levels of serum insulin-like growth factor I affect renal hemodynamics by stimulating the renin-angiotensin system,” Wesley J. Goedegebuure, MD, a doctoral candidate in the department of pediatrics, subdivision endocrinology, Erasmus University Medical Centre in Rotterdam, the Netherlands, and colleagues wrote in the study background. “Also, in GH-deficient children, GH treatment has been shown to increase kidney length and total kidney volume. It is essential to ascertain longitudinal data after cessation of GH treatment, to investigate the possible effects of higher serum IGF-1 levels during childhood on GFR in adulthood.”
In a longitudinal study, Goedegebuure and colleagues analyzed data from 261 young adults born small for gestational age who were previously treated with GH therapy (53.2% women), recruited for a Dutch study between 2002 and 2010. GH treatment was discontinued at the attainment of adult height (mean duration of treatment, 8.6 years; mean age at GH cessation, 21 years); participants were invited to join a follow-up study evaluating eGFR at cessation of GH treatment, 6 months, 2 years and 5 years. Researchers compared eGFR, blood pressure and urinary albumin to creatinine ratio 5 years after cessation of GH with untreated, age-matched controls aged 18 to 24 years, including 56 untreated adults born small for gestational age with persistent short stature, 118 adults born small for gestational age with spontaneous catch-up growth and 135 adults born normal size for gestational age.
The researchers found that eGFR decreased during the first 6 months after cessation of GH treatment; however, measurements remained within the normal range (mean, 124.6 vs. 120.2 mL/min/1.73 m2; P < .001). From 6 months to 2 years, eGFR decreased from a mean of 120.2 mL/min/1.73 m2 to 117.7 mL/min/1.73 m2, with no changes thereafter.
“The higher GFR at cessation, while still on GH treatment, was probably caused by a stimulation of the renin-angiotensin system due to the higher serum IGF-I levels, which has also been described in an earlier study in patients with GH deficiency,” the researchers wrote. “However, we did not find a correlation between serum IGF-I levels and GFR in the GH-treated young adults born small for gestational age, which might be explained by the lack of variability in serum IGF-1 levels and GFR in this population.”
Adults treated with GH therapy had similar BP and urinary albumin to creatinine ratio measurements vs. healthy controls born small for gestational age and appropriate for gestational age.
“Our 5 years longitudinal follow-up study shows a decrease in GFR during 6 months after GH cessation, but thereafter GFR remained stable and within the normal range,” the researchers wrote. “IGF-I levels were not associated with the decrease in GFR values in the first 6 months. The comparison at 5 years after GH cessation of GH-treated young adults born small for gestational age to a control group of young adults born either small for gestational age or appropriate for gestational age shows similar values in GFR, blood pressure and urinary albumin excretion. Our results show that long-term GH treatment in children born small for gestational age has no unfavorable effects on kidney function in early adulthood.” – by Regina Schaffer
Disclosure: One of the authors reports he received an independent research grant from Novo Nordisk.
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