Endocrine Abstracts

Background: Chronic renal failure can cause significant growth impairment. Many factors contribute towards growth failure and it has a significant impact on morbidity, mortality and quality of life. Patients who undergo renal transplantation experience some ’catch-up’ growth but most patients do not reach their target height. It is important that growth is monitored regularly and growth failure addressed, including offering patients growth hormone (GH) where appropriate.

Objective: We appraised our current practice to see how well we are monitoring growth in renal failure patients and if we are offering GH to eligible patients.

Method: We defined standards from NICE guidelines and Bristol guidelines endorsed by BSPED. We collected data from 76 patients on haemodialysis, peritoneal dialysis or post-renal transplant.

Results: We found 16/44 (36%) post-transplantation and 20/32 (62%) dialysis patients had growth failure as defined by height <2^nd centile, slightly higher than quoted in the literature (29 and 41% respectively). 53/76 had growth charts in their notes, and 39/53 had their height and weight plotted regularly. 12 patients were potentially eligible for GH and not previously offered it. 11 patients were on or had previously received GH and were managed in line with NICE guidance.

Conclusions: Growth monitoring needs to be improved in renal failure patients. Growth failure should be highlighted in the problem list and addressed at clinic visits to improve their growth. 12 patients need discussing jointly by the nephrology and endocrinology teams and considering for GH. Patients on or who have had GH are managed appropriately.

Impact on Practice: Four patients in the post-transplantation group (first group reviewed) have been offered GH and two families accepted it. Eight patients are currently being reviewed. Growth charts have been placed in all patient notes. Findings have been shared with the nephrology team in a local meeting to improve awareness.