Unit of Endocrinology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
Department of Pediatrics, IRCCS Istituto Giannina Gaslini, University of Genova, Genova, Italy.
Front Endocrinol (Lausanne). 2020 Sep 2;11:587. doi: 10.3389/fendo.2020.00587. eCollection 2020.
The management of children and adolescents with chronic kidney disease (CKD) and growth failure candidate for recombinant human growth hormone therapy (rhGH) is based on an appraisal of the literature established on a 2006 consensus statement and 2019 Clinical practice recommendations. The performance of these guidelines has never been tested. The objective of this study was to establish the level of adherence to international guidelines based on the 2006 consensus and the 2019 criteria that lead to the initiation of growth hormone treatment by both pediatric endocrinologists and pediatric nephrologists. A multidisciplinary team of pediatric endocrinologists and pediatric nephrologists, members of the Italian Society of Pediatric Endocrinology or of the Italian Society of Pediatric Nephrology, discussed and reviewed the main issues related to the management of pediatric patients with CKD who need treatment with rhGH. Experts developed 11 questions focusing on risk assessment and decision makings in October 2019 and a survey was sent to forty pediatric endocrinologists ( = 20) and nephrologists ( = 20) covering the whole national territory. The results were then analyzed and discussed in light of current clinical practice guidelines and recent recommendations. Responses were received from 32 of the 40 invited specialists, 17 of whom were pediatric endocrinologists (42.5%) and 15 pediatric nephrologists (37.5%). Although all the centers that participated in the survey agreed to follow the clinical and biochemical diagnostic work-up and the criteria for the treatment of patients with CKD, among the Italian centers there was a wide variety of decision-making processes. Despite current guidelines for the management of children with CKD and growth failure, its use varies widely between centers and rhGH is prescribed in a relatively small number of patients and rarely after kidney transplantation. Several raised issues are not taken into account by international guidelines and a multidisciplinary approach with mutual collaboration between specialists will improve patient care based on their unmet needs.
儿童和青少年慢性肾脏病（CKD）和生长障碍患者的管理（候选者）适合接受重组人生长激素治疗（rhGH），其管理基于对文献的评估，该文献建立在 2006 年的共识声明和 2019 年的临床实践建议之上。这些指南的执行情况从未经过检验。本研究的目的是根据 2006 年的共识和 2019 年的标准，评估意大利儿科内分泌学会和意大利儿科肾脏病学会成员的儿科内分泌医生和儿科肾脏病医生启动生长激素治疗的情况，以确定其对国际指南的遵守程度。一个由儿科内分泌医生和儿科肾脏病医生组成的多学科团队，讨论和回顾了与需要接受 rhGH 治疗的患有 CKD 的儿科患者管理有关的主要问题。专家们在 2019 年 10 月围绕风险评估和决策制定了 11 个问题，并向全国范围内的 40 名儿科内分泌医生（=20 名）和儿科肾脏病医生（=20 名）发送了一份调查。然后根据当前的临床实践指南和最新建议对结果进行分析和讨论。在受邀的 40 名专家中，有 32 名回复了调查，其中 17 名为儿科内分泌医生（42.5%），15 名为儿科肾脏病医生（37.5%）。尽管参与调查的所有中心都同意遵循 CKD 患者的临床和生化诊断，并遵循患者的治疗标准，但意大利的中心之间存在着决策过程的多样性。尽管有儿童 CKD 和生长障碍的管理指南，但在各个中心的使用情况差异很大，rhGH 仅在少数患者中开具，且很少在肾移植后开具。一些提出的问题并没有被国际指南所考虑，专家之间的多学科合作和相互协作将根据患者的未满足需求改善其护理。
