Obstacles to the prescribing of growth hormone in children with chronic kidney disease

Larry A. Greenbaum, Guillermo Hidalgo, Deepa Chand, Myra Chiang, Katherine Dell, Theresa Kump, Lena Peschansky, Holly K. Smith, Mary Boyle, Michelle Kopf, Lisa C. Metz, Margaret Kamel, John D. Mahan

    Research output: Contribution to journalArticlepeer-review

    24 Scopus citations

    Abstract

    Despite its effectiveness, recombinant human growth hormone (rhGH) is under-utilized in short children with chronic kidney disease (CKD). We conducted a multicenter study to explore the obstacles preventing children with CKD from receiving rhGH. We investigated the use of rhGH in 307 children with CKD from seven pediatric nephrology centers. Among the 110 patients who fell below the 5th percentile, 56 (51%) had not received rhGH. The most common reasons given for these children not receiving rhGH were family refusal, secondary hyperparathyroidism, and non-compliance. However, no explanation was apparent for 25% of the short children with CKD. Boys were more likely than girls to receive rhGH (65% vs 31%; P = 0.002). Use of rhGH was similar in African Americans and non-Hispanic Whites. Children who had received rhGH achieved a 0.5 increase in height z-score in the first year after the initiation of rhGH therapy. Children who had not received rhGH achieved a 0.03 increase in height z-score during the first year after falling below the 5th percentile (P = 0.005 vs the children who had received rhGH). Waiting for insurance company approval led to a significant delay in the initiation of rhGH treatment in 18% of patients. The fact that more than 50% of short children with CKD did not receive rhGH is secondary to multiple factors, many of which may be amenable to intervention efforts.

    Original languageEnglish
    Pages (from-to)1531-1535
    Number of pages5
    JournalPediatric Nephrology
    Volume23
    Issue number9
    DOIs
    StatePublished - Sep 2008

    Keywords

    • Children
    • Growth hormone
    • Kidney diseases
    • Secondary hyperparathyroidism
    • Short stature

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