Twenty years of growth hormone treatment in dialyzed children in Poland-Results of national multicenter study.

Purpose: The aim of the study was to analyze the effect of recombinant human growth hormone (rhGH) therapy and to establish factors influencing growth rate in dialyzed children in Poland. Methods: We retrospectively analyzed medical records of 81 children with end-stage renal disease (ESRD) on chronic dialysis treated with rhGH for >= 12 months between 1994 and 2014. The following data were recorded: cause of ESRD, dialysis modality, age at the dialysis and rhGH initiation [years]. In addition, growth [cm], [standard deviation score - SDS], body mass index [SDS], skeletal age [years], bone mineral density [SDS], hemoglobin, total protein, albumin, urea, creatinine, calcium, phosphorus, calcium phosphorus product, PTH, and alkaline phosphatase were measured at the baseline and after 12 months. Results: Growth velocity in 81 children during one-year rhGH treatment was 7.33 +/- 2.63 cm (.SDS 0.36 +/- 0.43). Height SDS increased significantly (-3.31 +/- 1.12 vs. -2.94 +/- 1.15, p < 0.001). Children on peritoneal dialysis (PD) (n = 51) were younger than children on hemodialysis (HD) (n = 30) (9.92 +/- 3.72 vs. 12.32 +/- 3.11 years, p = 0.003). Delta SDS did not differ between PD and HD children (0.40 +/- 0.33 vs. 0.30 +/- 0.47, p = 0.311). Growth velocity (Delta SDS) correlated with age at dialysis initiation (r = -0.30, p = 0.009), age at rhGH treatment initiation (r = -0.35, p = 0.002), skeletal age (r = -0.36, p = 0.002), BMI SDS (r = -0.27, p = 0.019), and PTH (r = -0.27, p = 0.017). No correlation between growth velocity and other parameters was observed. Conclusions: Treatment with rhGH in children with ESRD is effective and safe irrespective of dialysis modality. Early initiation of rhGH therapy is a crucial factor determining response to the treatment in children with ESRD.