Double-blind, placebo-controlled study of growth hormone treatment in elderly patients undergoing chronic hemodialysis: anabolic effect and functional improvement

Am J Kidney Dis. 1999 Apr;33(4):709-17. doi: 10.1016/s0272-6386(99)70223-4.

Abstract

Elderly patients with end-stage renal disease often have protein and/or caloric malnutrition that severely affects general well-being and mortality. Uremia is associated with resistance to the action of growth hormone (GH). This resistance could be of clinical importance in elderly dialysis patients. In the present study, the effects of GH treatment were assessed in elderly patients receiving chronic hemodialysis. Twenty hemodialysis patients with a mean age of 71.7 years (range, 53 to 92 years) were included on a 6-month, randomized, double-blind, placebo-controlled trial of GH treatment. The dose of GH was 66.7 microgram/kg, administered subcutaneously three times weekly immediately after each dialysis session. Body composition was measured using total-body potassium levels, computed tomography of the lower leg, and bioelectrical impedance analysis. Serum albumin concentrations and handgrip strength were also measured. GH treatment increased the serum concentration of insulin-like growth factor-I (IGF-I), IGF-I/IGF-binding protein-3 ratio, fat-free mass, and the serum concentration of albumin compared with placebo. The number of patients with serum albumin levels less than 40 g/L was reduced by a factor of three in the GH-treated group. Handgrip strength increased in response to GH treatment compared with placebo. Six months of GH treatment in elderly hemodialysis patients produced anabolic effects, with improved muscle performance. Also, the number of patients with low albumin levels was markedly reduced, indicating improved nutritional status and/or attenuated catabolism. These are all important beneficial effects for individual patient outcomes.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Body Composition
  • Double-Blind Method
  • Female
  • Hand Strength
  • Human Growth Hormone / administration & dosage
  • Human Growth Hormone / therapeutic use*
  • Humans
  • Injections, Subcutaneous
  • Insulin-Like Growth Factor Binding Protein 3 / analysis
  • Insulin-Like Growth Factor I / analysis
  • Male
  • Middle Aged
  • Renal Dialysis*
  • Serum Albumin / analysis
  • Treatment Outcome

Substances

  • Insulin-Like Growth Factor Binding Protein 3
  • Serum Albumin
  • Human Growth Hormone
  • Insulin-Like Growth Factor I