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Achieving normal growth is one of the most challenging problems in the management of children with chronic kidney disease (CKD). Treatment with recombinant human growth hormone (GH) promotes longitudinal growth and likely enables children with CKD and short stature to reach normal adult height. Here, members of the European Society for Paediatric Nephrology (ESPN) CKD–Mineral and Bone Disorder (MBD), Dialysis and Transplantation working groups present clinical practice recommendations for the use of GH in children with CKD on dialysis and after renal transplantation. These recommendations have been developed with input from an external advisory group of paediatric endocrinologists, paediatric nephrologists and patient representatives. We recommend that children with stage 3–5 CKD or on dialysis should be candidates for GH therapy if they have persistent growth failure, defined as a height below the third percentile for age and sex and a height velocity below the twenty-fifth percentile, once other potentially treatable risk factors for growth failure have been adequately addressed and provided the child has growth potential. In children who have received a kidney transplant and fulfil the above growth criteria, we recommend initiation of GH therapy 1 year after transplantation if spontaneous catch-up growth does not occur and steroid-free immunosuppression is not a feasible option. GH should be given at dosages of 0.045–0.05 mg/kg per day by daily subcutaneous injections until the patient has reached their final height or until renal transplantation. In addition to providing treatment recommendations, a cost-effectiveness analysis is provided that might help guide decision-making., This Evidence-Based Guideline developed by members of the European Society for Paediatric Nephrology CKD-MBD, Dialysis and Transplantation working groups presents clinical practice recommendations for the use of growth hormone in children with chronic kidney disease on dialysis and after renal transplantation.

PubMedID: 28873971 In patients with chronic kidney disease (CKD), renal synthesis of active Vitamin D [1, 25-dihydroxyVitamin D (1, 25(OH)2D)] declines and is associated with hypocalcaemia, secondary hyperparathyroidism and the spectrum of CKD-mineral and bone disorder (MBD). In advanced CKD, active Vitamin D analogues, including alfacalcidol, calcitriol and paricalcitol, are routinely administered. There are few studies on the use of Vitamin D analogues in children with CKD and on dialysis. It is difficult to define bone-specific outcomes that can guide treatment with active Vitamin D analogues in children with CKD-MBD. A core working group (WG) of the European Society for Paediatric Nephrology (ESPN) CKD-MBD and Dialysis WGs has developed recommendations for the use of active Vitamin D therapy in children with CKD and on dialysis. A second document in parallel with this one covers treatment recommendations for native Vitamin D therapy. The WGs have performed an extensive literature review to include systematic reviews and randomized controlled trials in adults and children with CKD and prospective observational studies in children with CKD. The Grading of Recommendation, Assessment, Development and Evaluation (GRADE) system was used to develop and grade the recommendations. In the absence of applicable study data, the opinion of experts from the ESPN CKD-MBD and Dialysis WGs is provided, but clearly GRADE-ed as such and must be carefully considered by the treating physician and adapted to individual patient needs as appropriate. © The Author 2017. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. National Institute for Health Research RS holds a fellowship with the National Institute for Health Research (NIHR). Members of the ESPN CKD-MBD Working Group: Belgium: A. Prytula, Ghent University, Utopaed. France: J. Bachetta., University Children’s Hospital, Lyon. Germany: D. Haffner., Hannover Medical School, Hannover. G. Klaus, University Children’s Hospital, Marburg. Hungary: G. Reusz, Semmelweis University, Budapest. Italy: E. Verrina, G. Gaslini Institute, Genoa. The Netherlands: J. Groothoff, Academic Medical Center, Amsterdam. Spain: M.A. Gamero, Reina Sofía Universitary Hospital, Córdoba. Russia: E. Petrosyan, Russian National Research Medical University, Moscow. Turkey: S. A. Bakkaloglu, Gazi University Hospital, Ankara; I. Dursun, Erciyes University Faculty of Medicine, Kayseri. United Kingdom: R. Shroff, Great Ormond Street Hospital, London. Members of the ESPN Dialysis Working Group: Austria: C. Aufricht, Medical University of Vienna, Vienna. Belgium: J. Vande Walle, University Hospital Ghent, Department of Pediatric Nephrology/Urology, Ghent. Czech Republic: K. Vondrak, University Hospital Motol, Charles University Prague, 2nd Faculty of Medicine, Prague. Finland: T. Holtta, Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki. France: B. Ranchin, Centre de Référence des Maladies Rénales Héréditaires, Hospices Civils de Lyon and Université Lyon, Lyon. M. Fischbach, Hautepierre University Hospital, Strasbourg. Germany: Claus Peter Schmitt, University of Heidelberg, Heidelberg. Günter Klaus, University Children’s Hospital, Marburg. Greece: Constantinos J. Stefanidis, A. and P. Kyriakou Childrens Hospital, Athens; N. Printza, Aristotle University of Thessaloniki, Thessaloniki. Italy: Alberto Edefonti, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan; E. Verrina, Giannina Gaslini Children’s Hospital, Dialysis Unit, Genova; E. Vidal, University Hospital of Padova, Padova. Lithuania: A. Jankauskiene, Vilnius