GROWTH HORMONE TREATMENT IN CHILDREN WITH CHRONIC RENAL FAILURE: A META-ANALYSIS OF RANDOMISED CONTROLLED TRIALS

Vimalachandra D, Craig JC, Cowell C, Knight JF.

Centre for Kidney Research, Royal Alexandra Hospital for Children, PO Box 3515, Parramatta, NSW 2124, Australia.

Objective: To evaluate the benefits and harms of recombinant human growth hormone (rHuGH) treatment in children with chronic renal failure.

Methods: Randomised controlled trials (RCTs) were identified through relevant sources. Two reviewers independently assessed studies for methodological quality and extracted data from eligible trials. 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.

Results: Ten RCTs of 481 children were identified. Shortcomings in trial design and reporting practice were common: blinding of outcome assessment was not stated in 6 trials, allocation concealment in 8, and intention to treat analysis in 8. Completeness of follow up ranged from 57 to 100% for between 6 months and 2.5 years. Treatment with rHuGH (28IU/m2/wk) resulted in a significant improvement in height standard deviation score (SDS) at 12 months (3 trials, WMD=0.76, 95% confidence limits=0.39 to 1.13) and 24 months (1 trial, WMD=1.5, 1.03 to 1.97). Treatment in the second year may be less effective (1 trial, WMD=0.4, -0.09 to 0.89). Children on growth hormone treatment grew approximately 3cm more than the placebo group during the first year of treatment (3 trials, WMD=2.95, 2.40 to 3.50). There were no significant difference in changes in height SDS between doses evaluated (28IU vs 14IU/m2/wk and 56IU vs 28IU/m2/wk). Compared to the 14IU/m2/wk group, there was a 1.4cm increase in growth velocity in the 28IU/m2/wk group. The reported side effects of rHuGH were equally repeated in the two groups.

Conclusion: rHuGH treatment in children with chronic renal failure improves height outcomes over two years' therapy. rHuGH treatment appears not to be associated with significant harms.

Presented at the Annual Scientific Meeting of the Australian and New Zealand Society of Nephrology, Melbourne, March 2000