Differential effects of growth hormone therapy in malnourished hemodialysis patients

被引:40
作者
Kotzmann, H
Yilmaz, N
Lercher, P
Riedl, M
Schmidt, A
Schuster, E
Kreuzer, S
Geyer, G
Frisch, H
Hörl, WH
Mayer, G
Luger, A
机构
[1] Univ Vienna, Dept Med 3, Div Endocrinol & Metab, A-1090 Vienna, Austria
[2] Univ Vienna, Dept Med 3, Div Nephrol, Vienna, Austria
[3] Univ Vienna, Dept Sports Med, Vienna, Austria
[4] Univ Vienna, Dept Med Comp Sci, Vienna, Austria
[5] Univ Vienna, Dept Pediat, Vienna, Austria
[6] Univ Vienna, Dept Radiol, Vienna, Austria
[7] Ludwig Boltzmann Inst Expt Endocrinol, Vienna, Austria
关键词
chronic renal failure. protein catabolism; bone turnover; erythropoietin; metabolic acidosis; nutrition and dialysis;
D O I
10.1046/j.1523-1755.2001.00971.x
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Background. Malnutrition is common in chronic hemodialysis patients and is associated with increased morbidity and mortality. Several factors such as metabolic acidosis, hyperparathyroid ism. and insulin as well as growth hormone (GH) resistance may lead to enhanced protein catabolism. Recombinant human growth hormone (rhGH) has been proposed as treatment of malnutrition because of its anabolic effects. Methods. In the present placebo-controlled. double blind study, the effects of three months of rhGH therapy on nutritional and anthropometric parameters, on bone metabolism and bone mineral density (BMD), as well as on polymorphonuclear leukocyte (PMNL) function and quality of life (QoL) were evaluated in 19 malnourished hemodialysis patients (10 females and 9 males) with a mean age of 59.3 +/- 13.4 years. RhGH (0.125 IU/kg) was given three times a week during the first four weeks and 0.25 IU/kg thereafter three times a week after each dialysis session. Results, Insulin-like growth factor I (IGF-I) concentration rose significantly from 169.2 +/- 95.6 ng/mL to 262.9 +/- 144.4 ng/mL (p < 0.01) in the group receiving rhGH. Albumin, prealbumin. transferrin. cholesterol. high-density lipoprotein (HDL) cholesterol, cholinesterase. predialytic creatinine. and blood urea nitrogen showed no significant changes during the three months in both groups. Total body fat (%TBF) was slightly reduced after three months (P = NS) in the patients receiving GH, whereas lean body mass LMM) remained stable during therapy. Procollagen I carboxy terminal peptide (PICP), a marker of bone formation, increased significantly after three months from 250.1 +/- 112.6 to 478.5 +/- 235.2 mug/L (P < 0.01) in the GH-treated patients, whereas parameters of bone resorption like telopeptide ICTP showed only a slight increase (50.3 +/- 18.5 vs. 70.0 +/- 39.5 mug/L, P = NS). BMD at the lumbar spine decreased significantly after three months in the treatment group (0.8 +/- 0.17 vs. 0.77 +/- 0.16 g/cm(2), p < 0.01), whereas BMD at the femoral neck remained stable in both groups. Phagocytic activity of PMNLs increased significantly after three months of therapy with rhGH, whereas other parameters of PMNL function were not affected by GH. QoL was slightly improved in the GH treated group, but decreased markedly in the placebo group. Conclusions. Three months of treatment with rhGH in malnourished patients on chronic hemodialysis causes a significant increase in IGF-I levels without significant changes in nutritional and anthropometric parameters. In contrast, bone turnover was enhanced with an initial decrease in BMD at the lumbar spine, and phagocytic activity of PMNLs was increased.
引用
收藏
页码:1578 / 1585
页数:8
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