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Short stature and growth hormone use in pediatric hemodialysis patients

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Abstract

End-stage renal disease (ESRD) causes growth retardation in children, and poor growth has been linked to worse outcomes. Recombinant human growth hormone (rhGH) can increase growth velocity and final adult height in pediatric ESRD patients. We aimed to identify clinical predictors of short stature (height standard deviation score (Ht SDS) <−1.88) and rhGH use in short stature pediatric hemodialysis patients. In 2002, the Centers for Medicare & Medicaid Services (CMS) Clinical Performances Measures (CPM) ESRD Project collected demographic, clinical and laboratory data as well as rhGH use on all in-center hemodialysis patients in the US aged <18 years. The odds ratios (OR) of short stature and rhGH use for individual predictors were determined by multivariate logistic regression modeling. Six-hundred and fifty-one (92%) of 710 eligible patients were included for analysis. Of these, 266 (41%) had Ht SDS <−1.88. After adjustment, short stature was predicted by congenital / urologic causes of ESRD ((OR 5.4; 95% confidence interval [CI], 2.1–13.8; p <0.001) in patients aged 10–14 years; (OR 2.8; 95% CI, 1.5–5.4; p <0.01) in patients aged 15–18 years) and increasing years on dialysis ((OR 1.2; 95% CI, 1.1–1.4; p <0.01) in patients aged 10–14 years; (OR 1.2; 95% CI, 1.1–1.4; p <0.001) in patients aged 15–18 years). Of 266 short stature patients, 214 (80.5%) had data on rhGH use. Of these, 80 (37%) had been prescribed rhGH. After adjustment, use of rhGH in short-stature patients was predicted by white race (OR 2.1; 95% CI, 1.1–4.0; p <0.05), increasing years on dialysis (OR 1.13; 95% CI, 1.05–1.22; p <0.01) and patients with BMI <16.6 kg/m2 (OR 3.1; 95% CI, 1.2–8.4; p <0.05). Increasing age and level of intact parathyroid hormone were not associated with rhGH use among short stature patients. A significant proportion of pediatric hemodialysis patients have short stature. The majority of short-stature patients are not receiving rhGH. Patients with short stature who are white, have longer durations on dialysis and have lower BMI are more likely to receive rhGH.

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Authors and Affiliations

  1. Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Gregory Gorman, Barbara Fivush & Alicia Neu

  2. The Centers for Medicare & Medicaid Services (CMS), Office of Clinical Standards and Quality, Baltimore, MD, USA

    Diane Frankenfield

  3. The Children’s Mercy Hospital, Kansas City, MO, USA

    Bradley Warady

  4. University of Washington/Children’s Hospital, Seattle, WA, USA

    Sandra Watkins

  5. Rhode Island Hospital, Providence, RI, USA

    Andrew Brem

  6. Pediatric Nephrology, Johns Hopkins University, 600 N. Wolfe Street / Park 335, Baltimore, MD, 21287-2535, USA

    Gregory Gorman

Authors
  1. Gregory Gorman
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  2. Barbara Fivush
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  3. Diane Frankenfield
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  4. Bradley Warady
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  5. Sandra Watkins
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  6. Andrew Brem
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  7. Alicia Neu
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Correspondence to Gregory Gorman.

Additional information

The views expressed in this manuscript are those of the authors and do not necessarily reflect official policy of the Centers for Medicare & Medicaid Services. This article was co-authored by LCDR Gregory H. Gorman, MC, USNR, while a Fellow in Pediatric Nephrology at the Johns Hopkins Medical Institutions. The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Navy, Department of Defense, or the US Government

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Gorman, G., Fivush, B., Frankenfield, D. et al. Short stature and growth hormone use in pediatric hemodialysis patients. Pediatr Nephrol 20, 1794–1800 (2005). https://doi.org/10.1007/s00467-005-1893-x

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  • DOI: https://doi.org/10.1007/s00467-005-1893-x

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