Nephrol Dial Transplant (2000) 15: 375-378
© 2000 European Renal Association-European Dialysis and Transplant Association
Vitamin D metabolite requirements in dialysed children receiving recombinant human growth hormone
gorzata Pa
czyk-Tomaszewska1kowska1ski2
1 Department of Paediatrics and Nephrology, Warsaw University Medical School and 2 Department of Mineral Metabolism and Bone Disease, National Food and Nutrition Institute, Warsaw, Poland, for the 3 Polish Multicenter Group of Growth Hormone Treatment of Children with End-Stage Renal Disease
Correspondence and offprint requests to:
Magorzata Paczyk-Tomaszewska, Department of Paediatrics and Nephrology, Warsaw University Medical School, Marszakowska 24, 00-576 Warsaw, Poland.
Background. The aim of the study was to assess the requirement of active vitamin D in dialysed children during treatment with recombinant human growth hormone (rhGH).
Methods. Twenty-six children (aged 5–15 years) were treated with rhGH for 6 months. The serum concentration of parathyroid hormone (PTH), alkaline phosphatase (AP), and calcium and phosphorus were measured in two groups of patients studied in the years 1994–1995 (group I) and 1995–1998 (group II) respectively. Group I received a constant dose of alfacalcidol that was sufficient to keep PTH below 200 pg/ml before rhGH treatment began. The serum PTH level was checked every 3 months. Alfacalcidol was administered to group II according to serum PTH levels checked on a monthly basis.
Results. In group I the PTH level increased after 3 and 6 months of rhGH treatment from mean level 73±60; 155±156 and 344±249 pg/ml respectively; P<0.05. AP activity increased after 6 months of treatment from 206±99 to 325±124 U/l respectively; P<0.01. The calcium level decreased from baseline after 3 months of treatment from 2.36±0.21 to 2.17±0.12 mmol/l respectively; P<0.05. In group II AP activity increased after 3 and 6 months of treatment from 272±169 to 332±192 and 404.9±219.8 U/l respectively; P<0.01. The mean level of phosphorus decreased after 6 months from 2.15±0.28 to 1.70±0.39 mmol/l respectively; P<0.01. In group II the mean dose of alfacalcidol increased by 60.9%.
Conclusions. In children with end-stage renal failure, higher doses of vitamin D are needed during rhGH treatment. During rhGH treatment, frequent control of serum PTH level is necessary.
Keywords: alfacalcidol; alkaline phosphatase; children; end-stage renal failure; growth hormone; growth retardation; parathyroid hormone
3 Participants: Department of Paediatric Nephrology, Gdansk; Research Institute. Polish Mother's Memorial Hospital, Lodz; Polish–American Children's Hospital, Collegium Medicum, Jagiellonian University, Cracow; District Hospital, Department of Paediatrics, Rzeszow; The Children's Memorial Health Institute, Warsaw; Department of Paediatrics Silesian School of Medicine, Dialysis Division, Zabrze.