Clinical practice recommendations for growth hormone treatment in children with chronic kidney disease
Clinical practice recommendations for growth hormone treatment in children with chronic kidney disease
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DOI：
10.1038/s41581-019-0161-4
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发表时间：
2019-09-01
影响因子：
41.5
通讯作者：
Marks, S.
中科院分区：
文献类型：
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作者：
Drube, Jens;Wan, Mandy;Marks, S.
实现正常生长是儿童慢性肾脏疾病（CKD）管理中最具挑战性的问题之一。重组人生长激素（GH）治疗促进纵向生长，可能使CKD和身材矮小的儿童达到正常的成人身高。在这里，欧洲儿科肾脏病学会（ESPN） CKD-矿物质和骨骼疾病（MBD）、透析和移植工作组的成员提出了在透析和肾移植后CKD患儿中使用生长激素的临床实践建议。这些建议是根据由儿科内分泌学家、儿科肾病学家和患者代表组成的外部咨询小组的意见制定的。我们建议3-5期CKD患儿或透析患儿如果有持续性生长衰竭（定义为身高低于年龄和性别的第3个百分位数，身高速度低于第25个百分位数），一旦其他潜在的可治疗的生长衰竭风险因素得到充分解决，并提供儿童有生长潜力，则应考虑生长激素治疗。在接受肾脏移植并符合上述生长标准的儿童中，如果没有发生自发的追赶生长，并且无类固醇免疫抑制不是可行的选择，我们建议在移植后1年开始生长激素治疗。生长激素每日皮下注射剂量为0.045-0.05 mg/kg，直至患者达到最终身高或肾移植。除了提供治疗建议外，还提供了可能有助于指导决策的成本效益分析。
Achieving normal growth is one of the most challenging problems in the management of children with chronic kidney disease (CKD). Treatment with recombinant human growth hormone (GH) promotes longitudinal growth and likely enables children with CKD and short stature to reach normal adult height. Here, members of the European Society for Paediatric Nephrology (ESPN) CKD-Mineral and Bone Disorder (MBD), Dialysis and Transplantation working groups present clinical practice recommendations for the use of GH in children with CKD on dialysis and after renal transplantation. These recommendations have been developed with input from an external advisory group of paediatric endocrinologists, paediatric nephrologists and patient representatives. We recommend that children with stage 3-5 CKD or on dialysis should be candidates for GH therapy if they have persistent growth failure, defined as a height below the third percentile for age and sex and a height velocity below the twenty-fifth percentile, once other potentially treatable risk factors for growth failure have been adequately addressed and provided the child has growth potential. In children who have received a kidney transplant and fulfil the above growth criteria, we recommend initiation of GH therapy 1 year after transplantation if spontaneous catch-up growth does not occur and steroid-free immunosuppression is not a feasible option. GH should be given at dosages of 0.045-0.05 mg/kg per day by daily subcutaneous injections until the patient has reached their final height or until renal transplantation. In addition to providing treatment recommendations, a cost-effectiveness analysis is provided that might help guide decision-making.