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2017 ; 18
(1
): 181
Nephropedia Template TP
gab.com Text
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English Wikipedia
Approach to growth hormone therapy in children with chronic kidney disease varies
across North America: the Midwest Pediatric Nephrology Consortium report
#MMPMID28558814
Akchurin OM
; Kogon AJ
; Kumar J
; Sethna CB
; Hammad HT
; Christos PJ
; Mahan JD
; Greenbaum LA
; Woroniecki R
BMC Nephrol
2017[May]; 18
(1
): 181
PMID28558814
show ga
BACKGROUND: Growth impairment remains common in children with chronic kidney
disease (CKD). Available literature indicates low level of recombinant human
growth hormone (rhGH) utilization in short children with CKD. Despite efforts at
consensus guidelines, lack of high-level evidence continues to complicate rhGH
therapy decision-making and the level of practice variability in rhGH treatment
by pediatric nephrologists is unknown. METHODS: Cross-sectional online survey
electronically distributed to pediatric nephrologists through the Midwest
Pediatric Nephrology Consortium and American Society of Pediatric Nephrology.
RESULTS: Seventy three pediatric nephrologists completed the survey. While the
majority (52.1%) rarely involve endocrinology in rhGH management, 26.8% reported
that endocrinology managed most aspects of rhGH treatment in their centers. The
majority of centers (68.5%) have a dedicated renal dietitian, but 20.6% reported
the nephrologist as the primary source of nutritional support for children with
CKD. Children with growth failure did not receive rhGH most commonly because of
family refusal. Differences in initial work-up for rhGH therapy include variable
use of bone age (95%), thyroid function (58%), insulin-like growth factor-1
(40%), hip/knee X-ray (36%), and ophthalmologic evaluation (7%). Most pediatric
nephrologists (95%) believe that rhGH treatment improves quality of life, but
only 24% believe that it improves physical function; 44% indicated that rhGH
improves lean body mass. CONCLUSIONS: There is substantial variation in pediatric
nephrology practice in addressing short stature and rhGH utilization in children
with CKD. Hence, there may be opportunities to standardize care to study and
improve growth outcomes in short children with CKD.