A substantive amendment to this systematic review was last made on 21 August 2001. Cochrane reviews are regularly checked and updated if necessary.Background: A systematic review of human growth hormone (hGH) treatment was undertaken to evaluate growth outcomes to establish the effect of treatment over time. We sought to establish if the growth outcomes remained linear over time or if there was a waning effect of the treatment. Secondly, we examined the effect of varying doses of the treatment. Thirdly, we explored the effect of the following factors on treatment: age, sex, pubertal status and the stage of CRF (pre-dialysis, on dialysis, post-transplant). Finally, the study evaluated potential side effects of hGH treatment.Objectives: To evaluate the benefits and harms of recombinant human growth hormone (hGH) treatment in children with chronic renal failure (CRF).
Search strategy: Published and unpublished randomised controlled trials (RCTs) were identified from the Cochrane Controlled Trials Register, Medline, Embase, article reference lists and through contact with local and international experts in the field.
Selection criteria: Randomised controlled trials (RCTs) were included if they were carried out in children aged 0-18 years, diagnosed with CRF who are pre-dialysis, on dialysis or post-transplant; if they compared hGH treatment with placebo/no treatment or two doses of hGH treatments; and if they included height outcomes.
Data collection and analysis: Two reviewers independently assessed studies for methodological quality and extracted data from eligible trials. The primary outcome measure was difference in mean change in height standard deviation score (SDS). Secondary outcome measures included change in height SDS from treatment onset to completion, change in height SDS during puberty, change in height velocity, final height, quality of life and adverse effects. To estimate summary treatment effects, data was pooled using a random effects model with calculation of weighted mean difference (WMD) for continuous outcomes and relative risk for categorical outcomes.
Main results: Ten RCTs involving 481 children were identified. Treatment with hGH (28 IU/mē/wk) resulted in a significant increase in height standard deviation score (SDS) at one year (four trials, WMD0.77, 95% confidence limits (CI) 0.51 to 1.04), and a significant increase in height velocity at six months (two trials, WMD 5.7 cm/yr, 95%CI 4.4 to 7.0) and one year (two trials, WMD 4.1 cm/yr, 95%CI 2.6 to 5.6), but there was no further increase in height indices during the second year of administration. Compared to the 14 IU/mē/wk group, there was a 1.4 cm/yr (0.6 to 2.2) increase in height velocity in the 28 IU/mē/wk group. The frequency of reported side effects of hGH were similar to that of the control group.
Reviewers' conclusions: On average, one year of 28 IU/mē/wk hGH in children with CRF results in a 4 cm/yr increase in height velocity above that of untreated controls, however, it is not certain if this will result in an increase in final adult height. Benefits of longer courses or higher doses of treatment warrants further study.
Citation: Vimalachandra D, Craig JC, Cowell C, Knight JF. Growth hormone for children with chronic renal failure (Cochrane Review). In: The Cochrane Library, Issue 1 2003. Oxford: Update Software.
This is an abstract of a regularly updated, systematic review prepared and maintained by the Cochrane Collaboration. The full text of the review is available in The Cochrane Library (ISSN 1464-780X). or from our electronic document delivery service.The Cochrane Library is prepared and published by Update Software Ltd. All rights reserved. See www.update-software.com or contact Update Software, info@update.co.uk, for information on subscribing to The Cochrane Library in your area. Update Software Ltd, Summertown Pavilion, Middle Way, Oxford OX2 7LG, UK
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File Reference: ab003264-20031