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Kidney Week

Abstract: SA-PO377

Barriers to Growth Hormone (GH) Use in Children with CKD

Session Information

  • Pediatric Nephrology - III
    November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

  • 1900 Pediatric Nephrology

Authors

  • Hendrickson, Isabella M., The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States
  • Berta, Caleb, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States
  • Diaz-Thomas, Alicia, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States
  • Hastings, Margaret Colleen, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States
Background

GH is safe and effective in improving height in children with CKD. The purpose of this study was to identify barriers to GH use for the treatment of short stature in children with CKD.

Methods

Retrospective chart review identified children treated in the nephrology clinic at Le Bonheur Children's Hospital with estimated glomerular filtration rates (eGFR) ≤ 60 ml/min/1.73 m2 via bedside Schwartz equation between January 1, 2017 until December 31, 2021. Males > 15 years old, females > 14 years old, and children < 3 years old were excluded. All children on GH at the most recent visit were included regardless of age, eGFR, or height percentile. Children having serum creatinine and height recorded within 7 days of one another during the study period were assessed. Barriers were evaluated for children not on GH with height percentiles ≤ 5%.

Results

94 children were identified with eGFR ≤ 60 ml/min/1.73m2. The cohort was 30% female, 51% black/African American, 41% white, 5% Hispanic/Latino, and had a median age of 11 years. Obstructive uropathy (27%), renal dysplasia (19%), and focal segmental glomerulosclerosis (13%) were the most common causes of CKD.

80 (85%) were not on GH and 14 (15%) were prescribed GH. Of the 14 patients on GH, 13 (93%) were male and 11 (79%) were white. Of the children not prescribed GH, 25 children (31%) had height percentiles ≤ 5% making them candidates for GH; there were 14 (56%) females, 13 (52%) black/African American, 9 (36%) white, and 2 (8%) Hispanic/Latinos in this group. Barriers identified were missed appointments/lost to follow up (8), severe developmental delay (7), severe hyperparathyroidism (4), delayed growth not identified by clinician (2), perceived adverse reaction (1), liver transplant (1), family declined treatment (1), and family reported not able to obtain (1).

Conclusion

Education on the importance of routine follow up appointments with more aggressive attempts to reschedule missed appointments may be beneficial in improving use of GH in children with CKD. Additionally, further education of families may lead to better control of hyperparathyroidism and other sequelae of CKD. The utility of GH therapy in children with severe neurologic impairments and CKD deserves further study. Finally, higher use of GH in white male children may suggest racial and gender inequality in provision of this treatment.