Growth Failure

Short stature is common in boys with uremia, and, after transplantation, catch-up growth is impaired. A small randomized, double-blind, placebo-controlled crossover study examined the short-term effects of testosterone on growth in short-statured boys undergoing hemodialysis (54). After an 8-wk run-in, eight boys with growth-retardation on regular hemodialysis were randomized to receive transdermal testosterone (topical dose 50 mg/m2/d) or placebo gel for 4 wk before crossover to the other treatment after a 6-wk washout period. Although a significant increase in short-term growth velocity (using knemometry) was reported, the randomization was unbalanced with a likely period effect (all boys starting on active treatment had subnormal pretreatment growth velocity, whereas those starting on placebo all had normal pretreatment growth velocity). The small sample size, period effects, and uncertain efficacy makes it difficult to interpret the growth results of this short-term study. Furthermore, the clinical significance of short-term growth acceleration is uncertain, because it may represent catch-up without necessarily predicting final height gain. Two other small, uncontrolled series do not support a therapeutic role for androgen therapy for delayed puberty in adolescents with uremia (49,50). More powerful and longer placebo-controlled studies are needed before even low-dose androgen therapy can be considered effective or safe for routine use.

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