Evaluation of insulin-like growth factor-1 (IGF-1)‎ IN children with chronic kidney diseases in Basra

الملخص EN

Objective: Malnutrition and growth delay are common in children with chronic kidney diseases and associated with a greater risk of morbidity and mortality.

Chronic kidney diseases results in complex metabolic and hormonal disturbances, particularly in the (GHIGF- IGFBP) axis; responsible for many important complications, such as growth retardation which is due to a relative growth hormone insensitivity and functional IGF deficiency as well as disease progression.

A case control study has been carried out to assess level of insulin like growth factor-1 (ILGF-1) in children with chronic kidney disease in relation to their nutritional status and some selected patients’ variables Methods: Forty one patients with chronic kidney diseases and 50 healthy children as a control group were selected from 1st of October 2015 till 15th March 2016.

The medical records were reviewed for all patients and the following information was collected: birth date, sex, age, onset of diagnosis of kidney diseases, presenting symptoms, modality of treatment (medical therapy, hemodialysis, continuous ambulatory peritoneal dialysis) and dietary history (three nonconsecutive 24 hours food record, food restriction and supplements).

Nutritional assessment was conducted by clinical evaluation for signs of malnutrition and anthropometric data such as (weight for age, height for age, mid upper arm circumferences and body mass index) were applied on appropriate growth charts.

Investigations done included: insulin like growth factor-1, renal function tests, serum electrolytes, and hemoglobin.

The severity of kidney diseases was assessed by calculation of glomerular filtration rate (GFR) for all patients.

Results: Out of 41 patients with chronic kidney diseases; 29 (70.7%) were males and 12 (29.3%) were females, 51.3% are diagnosed after the age of 5 years, with higher frequency of patients on conservative treatment 27 (65.9%), whereas only 8 (19.5%) were on continuous ambulatory peritoneal dialysis with less frequency of patients on hemodialysis (6 patients, 14.6%).

Higher frequency of school failure reported in children with chronic kidney diseases than control (41.4 and 8%, respectively), and more than 50% belong to illiterate parents with statistically significant results.

Malnutrition was significantly recorded in 63.4% patients with chronic kidney diseases (41 patients out of 26); their growth parameters were below 5th percentile.

Significantly inadequate dietary intake was reported in 73.1% of patients with malnutrition, and in 33.3% of patients without malnutrition.

Significantly low mean level of insulin like growth factor-1 recorded in patients with chronic kidney disease than control group (91.12±71 and 279±53.2, respectively), and in malnourished patients than those without malnutrition (47.11±19 and 167±65.6, respectively), p-value was 0.0001.

Modality of treatment and severity of chronic kidney diseases seem to have no obvious effect on nutritional status of studied patients.

Conclusions: Malnutrition in children with chronic kidney diseases is a major problem; essential to be recognized as early as possible, further studies on treatment with insulin like growth factor-1 analogues could provide an opportunity to improve management of growth failure of such patients.