Recombinant human insulin-like growth factor-1 induces an anabolic response in malnourished CAPD patients

bolic hormone that mediates most of the growth effects of ance in CAPD patients with protein-energy malnutrition. growth hormone. This study tested the hypothesis that recomrhIGF-1 administration may be an effective method for treating binant human IGF-1 (rhIGF-1) will induce an anabolic remalnutrition in maintenance dialysis patients. sponse in malnourished patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Methods. Six CAPD patients with protein-energy malnutrition underwent nitrogen balance studies in a clinical research Many adult patients undergoing either maintenance center for 35 days each. Throughout the study, patients were hemodialysis or chronic peritoneal dialysis show evimaintained on their same CAPD regimen prior to hospitalizadence for protein-energy malnutrition [1‐3]. The incition, and were fed a constant protein and energy intake that was similar to their diet prior to hospitalization. The first 15 dence of malnutrition in chronic peritoneal dialysis pahospital days were a baseline period; during the subsequent tients is reported to range from approximately 18 to 20-day period, patients were given subcutaneous injections of 56% [4, 5]. Many factors may engender malnutrition in rhIGF-1 (100 mg/kg/12 h), except for one patient who received maintenance peritoneal dialysis patients [6]. Inadequate 50 mg/kg/12 h for the first five days, followed by 100 mg/kg/12 intake of protein and energy is considered to be an imh for the following 15 days. Results. During the treatment with rhIGF-1, serum IGF-1 portant factor. Evidence also suggests that resistance to increased by about 100% (P 5 0.03), and nitrogen balance the anabolic effects of growth factors may contribute to became strongly positive (12.0 g/day, P 5 0.015 vs. baseline). the propensity for protein-energy malnutrition in mainThis anabolic effect was observed within hours after commenc- tenance dialysis patients. Because malnutrition is an iming the rhIGF-1 treatment and was largely caused by a 20% portant risk factor for morbidity and mortality in both decrease in peritoneal dialysate effluent nitrogen. There was a proportionate reduction in urine nitrogen and serum urea maintenance hemodialysis and chronic peritoneal dialnitrogen. This decrease in nitrogen output was sustained during ysis patients [7], this issue appears to be of considerable the entire 20 day of treatment with rhIGF-1. Serum phosphorus clinical importance. decreased significantly during the first several days of rhIGF-1 With the availability of growth factors manufactured treatment, whereas serum calcium increased significantly dur- by recombinant DNA techniques, a number of studies ing the rhIGF-1 treatment. Serum potassium and albumin did not change during the rhIGF-1 injections. There was no change have examined the nutritional effects of these comin body weight and body composition, as assessed by anthro- pounds in malnourished patients. In the past years, the pometry during the baseline or treatment phases of the study. most commonly used anabolic agent evaluated has been Some patients exhibited minor possible adverse events that recombinant growth hormone (rhGH). This hormone induces an anabolic response that has been observed in both acutely catabolic patients without renal disease and 1 The current address of Dr. Fouque is Department of Nephrology, %