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Nutrition
Figure 3: Fat Mass in Growth Hormone-treated Patients
reflected in changes in body composition.
53,54
In a six-month, double-
blind, placebo-controlled study in 20 MHD patients, Hansen et al.
54
4
documented significant increases in LBM (3.14±0.41kg; p<0.0001) and
3
~40% of
25% reduction in total fat mass
a reduction in fat mass (-3.05±0.75kg; p<0.001) in GH-treated patients
total fat mass reduction (see Figure 3).
52
The reduction in fat mass was most marked at the
2
trunk (-1.39±0.41kg). Changes in body composition were accompanied
1
by a significant (p<0.0001) increase in serum IGF-I levels.
0
In a comparable study, Johannsson et al.
54
showed the same effect on
-1
body composition in 20 elderly (mean age 71.7 years) MHD patients.
Change from baseline (kg)
-2
GH therapy administered three times weekly for six months increased
-3
LBM with a corresponding reduction in body fat. Serum albumin and
IGF-I levels also increased during treatment.
-4
Total fat mass Trunk fat mass Total lean body mass
Overall, no untoward effects of GH therapy in this population were
reported in these studies. However, it should be considered that
Change in total fat mass (kg), trunk fat mass (kg) and total lean body mass (kg) in growth
hormone-treated (0.044mg/kg/day) maintenance haemodialisis patients (n=9) after six exacerbation of glucose intolerance and hyperlipidaemia might occur
months. Data are mean ± standard error (SE).
Source: Hansen et al.
54
with prolonged therapy. Moreover, GH administration in severely
malnourished patients with low calorific/protein intake also requires
Likewise, in MHD patients receiving intra-dialytic parenteral nutrition careful monitoring.
and GH therapy, Schulman and co-workers
47
observed a reduction in
protein nitrogen appearance (PNA) as well as an increase in serum In summary, available data from small-scale, short-term trials show
albumin levels. that GH administration has potential as a therapeutic approach to
overcome uraemic malnutrition in MHD patients. However, it must be
Using stable isotope techniques to assess skeletal muscle protein remembered that these studies were performed on a small number of
homeostasis in MHD patients, Garibotto and colleagues
46
described a patients (≤11 patients in each treatment arm) and were of limited
significant improvement in muscle protein metabolism, with protein duration (maximum six months), and few were of randomised,
synthesis increasing from -15±2 to -8±2nmol/100ml/min during six controlled design. Administration of GH alone or in combination with
weeks of GH treatment. Consistent with these findings, Kopple et al.
48
parenteral nutrition in malnourished MHD patients appears to improve
found a strong and sustained anabolic effect of GH in six whole-body protein metabolism as well as affecting clinically beneficial
malnourished MHD patients as indicated by a positive nitrogen changes in body composition. However, many questions remain
balance (+2.35g/day; p=0.034 versus baseline) and a significant regarding the role of GH therapy in the optimal management of
reduction in serum urea nitrogen (SUN) (-32%; p=0.001) In seven malnutrition in MHD patients. The optimal GH dosage as well as the
MHD patients, Pupim and colleagues
53
observed a significant long-term effects of GH in this patient population are among the
improvement in net whole-body protein homeostasis, primarily as a issues that require resolution.
result of an 18% increase in whole-body protein synthesis. In many of
these studies, reductions in plasma amino acids, SUN and net urea Data from adequately-powered, randomised, controlled long-term trials,
nitrogen excretion were associated with increased serum IGF-I levels, such as that by Bo Feldt-Rasmussen
56
and the Adult Patients in Chronic
suggesting a general anabolic effect.
48
Dialysis Study Group in July 2007, provided important evidence that
long-term GH therapy is a valuable treatment option in malnourished
Improvements in protein metabolism with GH in MHD patients is MHD patients. ■
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