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Growth hormone metabolism in chronic kidney disease

Biff F Palmer, MD
William L Henrich, MD, MACP
Section Editor
Steve J Schwab, MD
Deputy Editor
Alice M Sheridan, MD


Progression to end-stage renal disease is associated with a variety of abnormalities in growth hormone regulation, including changes in its plasma concentration, in the regulation of its release, and in end-organ responsiveness. As an example, the plasma growth hormone concentration is commonly elevated in chronic kidney disease due to the interplay of several factors [1,2].

Decreased renal clearance appears to play a major role in the genesis of this problem since filtered growth hormone is normally reabsorbed in and metabolized by the proximal tubule [3].

Enhanced growth hormone secretion also may contribute to the rise in plasma levels, although it is likely to be of lesser importance. Children with end-stage renal disease have an increase in the number of secretory bursts of growth hormone when compared with children with normal renal function [4]. Why this occurs is not clear, but protein-calorie malnutrition and stress may play a role.

Plasma growth hormone levels fall to low-normal values after the institution of maintenance dialysis, an effect that may be mediated in part by acetate (which has now been largely replaced by bicarbonate) in the dialysis bath [5]. For reasons that are not well understood, the administration of recombinant human erythropoietin also leads to a reduction in the basal concentration of growth hormone [6].


A number of observations suggest that the hypothalamic-pituitary regulation of growth hormone is perturbed in chronic kidney disease [7]. As an example, normal individuals suppress growth hormone release in response to induced hyperglycemia; in contrast, glucose induces a paradoxical rise in growth hormone levels in advanced renal failure [8]. In addition, insulin-induced hypoglycemia, which is a potent stimulus to growth hormone release in normal subjects, elicits a blunted response in chronic kidney disease patients [9].

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Literature review current through: Nov 2017. | This topic last updated: Sep 13, 2017.
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