Factors predicting the near-final height in growth hormone-treated children and adolescents with chronic kidney disease

Context: GH therapy is an accepted measure to increase adult height in young prepubertal patients suffering from growth failure related to chronic kidney disease (CKD). The impact of GH therapy on final height (FH) in CKD patients of pubertal age is unclear. Objective: This study set out to analyze near-FH in a cohort of GH-treated CKD patients. Design, Settings, and Patients: Of 240 evaluable patients in the Pfizer International Growth Database (KIGS) with CKD, 39% were prepubertal and 61% were pubertal at baseline; 45% were on conservative treatment for CKD, 28% were on dialysis, and 27% were in the period after renal transplantation. Main Outcome Measures: Near-FH, relation to pubertal stage, and factors predictive of growth response were the main outcome measures. Results: Mean height SD scores increased continuously during GH treatment until near-FH by 1.2 and 1.6 in boys and girls, respectively. Meannear-FH differed significantly from prepubertal patients showing severely delayed puberty (-3.6), late pubertal patients (-2.9), early pubertal patients (-2.2), and prepubertal patients with normal onset of puberty (-2.0). The initial degree of stunting, degree of bone age retardation, duration of GH therapy, time spent on conservative treatment/dialysis, pubertal delay (>2 SD), gender, and age at start of GH treatment were significant predictors of growth response to GH therapy, explaining between 33 and 61% of the overall variability. Conclusions: Long-term GH therapy of CKD patients in prepubertal and pubertal age results in an increased adult height, but response is diminished in patients on dialysis and/or with severely delayed puberty.