From a clinical aspect, there are still a number of unsolved problems in patients with
end-stage renal disease, for instance intractable
malnutrition. The present study was undertaken to establish the
therapeutic effect of recombinant
human growth hormone (r-hGH) on the nutritional state and clarify the usefulness of the
insulin-like growth factor-I (
IGF-I)
insulin-like growth factor binding protein-1 (IGFBP-1) ratio as nutritional indices for prediction of the clinical response in uremic patients on
hemodialysis. Thirty
hemodialysis patients (13 females and 17 males, mean age 56.7 +/- 15.2 years) were studied who were suffering from
malnutrition and could not be treated by any of the usual nutritional
therapies; they were subjected to 0.5 IU/kg/week of r-hGH subcutaneously after
hemodialysis for 2 weeks. Blood samples were collected for measurement of the following plasma biochemical and hematological indices: serum
IGF-I,
IGFBP-1,
growth hormone, total
protein (TP),
prealbumin,
transferrin,
albumin, serum urea nitrogen (SUN),
creatinine, hematocrit, and
amino acids. Immediately after r-hGH administration, SUN,
essential amino acid and nonessential
amino acid changed from 67.7 +/- 12.3 to 56.5 +/- 10.5 mg/dl (p < 0.05), from 798 +/- 84 to 1,115 +/- 208 microM/l (p < 0.05 vs. baseline), and from 2,185 +/- 221 to 2,814 +/- 621 microM/l (p < 0.05), respectively. Serum
IGF-I increased markedly from 193 +/- 49 to 321 +/- 81 ng/ml, whereas serum
IGFBP-1 decreased from 139 +/- 13 to 81 +/- 19 micrograms/l (p < 0.05). Four weeks after r-hGH administration, serum TP and
albumin increased from 5.5 +/- 0.2 to 6.0 +/- 0.3 g/dl (p < 0.05) and from 3.2 +/- 0.2 to 3.6 +/- 0.3 g/dl (p < 0.05), respectively. Serum
IGF-I/
IGFBP-1 ratio was significantly higher in patients with an increase of 0.5 g/dl or more in
serum albumin than in other patients with poor response and the control group before r-hGH administration. Patients with marked improvement in
serum albumin showed an
IGF-I/
IGFBP-1 ratio of 2 or less. On the other hand, patients without favorable improvement in
serum albumin had a higher ratio of 4 or more. We conclude that r-hGH and
IGF-I improve the malnutritional state by alleviating
hypoproteinemia and abnormality of serum
amino acid profile in uremic patients on
hemodialysis. In addition, the serum
IGF-I/
IGFBP-1 ratio is useful not only as a nutritional parameter but also as a predicting index of responsiveness to r-hGH.