The effect of recombinant human growth hormone treatment on bone and mineral metabolism in haemodialysis patients

Background: Uraemia and chronical haemodialysis areassociated with an abnormal growth hormone (GH)-insulin-like growth factor(IGF) axis which may contribute to malnutrition and renal bone disease.Short-term studies have shown a beneficial effect of treatment withrecombinant human growth hormone (rhGH) on nutritional status in patientson haemodialysis. In the present study, we evaluated the effect of rhGH onbone and mineral metabolism. Methods: Twenty chronicmalnourished patients on haemodialysis took part in a double-blind, placebocontrolled trial with subcutaneous injections of rhGH (4IU/m²/day) or placebo for 6 months.Results: During rhGH treatment, serum IGF-1 increased264±52% (mean±SEM) (P<0.008). There were nosignificant changes in biochemical markers of mineral metabolism (serumionized calcium, phosphate and parathyroid hormone). Among markers of bonemetabolism, there was a significant increase in serum procollagen type IC-terminal propeptide (maximum 155±8%, P<0.001) and nosignificant changes in serum alkaline phosphatase. Bone densitometry showeda significant decrease in whole body bone mineral content(95.7±1.2%) after 6 months treatment.Conclusion: The effects of 6 months treatment withrhGH seen in this study are best explained by a GH- or IGF-1-inducedincreased bone turnover. Long-term treatment in larger cohorts followed bybone densitometry and, preferentially, bone histomorphometry are needed toevaluate whether this is a beneficial effect in haemodialysis patients.