Gorman G et al. (2005) Short stature and growth hormone use in pediatric hemodialysis patients. Pediatr Nephrol 20: 1794–1800

Short stature is common among pediatric hemodialysis patients, and is an indicator of poor outcome. A retrospective analysis of data from the US Centers for Medicare & Medicaid Services End-stage Renal Disease Clinical Performance Measures Project has confirmed that many children with renal failure are not prescribed recombinant human growth hormone (rhGH), despite its potential benefits. The study also identifies worrying racial and weight-related disparities in rhGH use.

Of the 651 children (age 0–17 years) included in the study, 41% were of short stature (STANDARDIZED HEIGHT SCORE <−1.88). Patients with end-stage renal disease of congenital or urologic origin, and those who had been on dialysis for longer, were more likely to be of short stature. Only 80 of the 214 short stature patients for whom data on rhGH were available had received the hormone. Growth hormone use was positively associated with white race (ODDS RATIO [OR] 2.1, 95% CI 1.1–4.0; P <0.05), duration of dialysis (OR 1.13 per extra year of dialysis, 95% CI 1.05–1.22; P <0.01) and BMI below 16.5 kg/m2 (OR 3.1, 95% CI 1.2–8.4; P <0.05), but was independent of height and age.

Risk of rhGH-related adverse effects, such as increased parathyroid hormone levels, might discourage physicians from prescribing the treatment. Nevertheless, Gorman et al. note that other factors act as unnecessary barriers to rhGH use. As increased BMI can reflect gain of weight rather than height, such a change should not preclude rhGH prescription. In addition, efforts should be made to identify the causes of, and thereby dispel, racial disparities in rhGH use.