Source: BMJ  |  Posted 10 years ago

Negative nitrogen balance improves and total nitrogen appearance rate significantly falls after patients who are critically ill with acute renal failure are given recombinant human growth hormone.

These changes correspond to increases in serum growth hormone, insulin-like growth factor (IGF)-1, IGF-1 binding protein 3 and leptin levels after growth hormone administration, according to nephrologists in Portland, Maine and Nashville, Tennessee, United States.

They conducted an open-label pilot trial at an intensive care unit in a tertiary care unit to determine the effect of recombinant human growth hormone 100 ?g/kg/d for six days on metabolic and nutritional parameters in five highly catabolic, malnourished patients with acute renal failure. Each patient served as his or her own control.

Entry criteria included clinical evidence of malnutrition. The parameters were serum albumin level above 3.2 g/dL, prealbumin level of 20 mg/dL and IGF-1 level below 200 ng/mL.

The study consisted of three stages - a three-day baseline, six-days of treatment and a three-day washout.

Blood and urine samples were taken daily throughout the study to calculate normalised protein catabolic rate, total nitrogen appearance rate and nitrogen balance. Metabolic and inflammatory parameters were also measured.

The nephrologists reported that there were significant changes in total nitrogen appearance rate, normalised protein catabolic rate and nitrogen balance during the study's three phases.

Total nitrogen appearance rate fell from 43.3 ? 24.4 g/d at baseline to 25.2 ? 16.5 g/d during treatment. There was a further decline in total nitrogen appearance rate to 16.2 ? 8.3 g/d during washout. Nitrogen balance improved from -31.8 ? 21.4 g/d at baseline to -12.9 ? 10.3 g/d during treatment and to -4.1 ? 4.0 g/d in the washout phase.

There were also significant changes in levels of blood urea nitrogen, phosphorus, serum growth hormone, IGF-1 and serum leptin levels after growth hormone was given. There was a statistically significant rise in serum albumin during washout (3.1 g/dL) from the level during treatment (2.7 ? 0.7 g/dL).