OBJECTIVE: To review the normal function of the growth hormone (GH) insulin-like growth factor (IGF) axis, how it is altered in end-stage renal failure, how this may contribute to malnutrition in dialysis patients, and how therapy with recombinant human growth hormone (rHuGH) and recombinant human IGF-I (rHuIGF-1) might be used to treat malnutrition in these patients. DATA SOURCES: Studies in the literature dealing with the GH-IGF endocrine axis and its role in uremic malnutrition. STUDY SELECTION: Eight studies in which uremic adults were treated with either rHuGH or rHuIGF-I. DATA EXTRACTION: Data were abstracted from all of these studies. RESULTS: The review shows that there are marked abnormalities of the GH-IGF axis in uremic patients and that these lead to a state of GH resistance, which can be overcome by pharmacological doses of rHuGH. A small number of clinical studies in uremic adults suggests that both rHuGH and rHuIGF-I have dramatic beneficial effects on nutritional status in these patients. CONCLUSIONS: rHuGH and rHuIGF-I have both been shown to have a beneficial effect on nutritional status in short-term studies on small numbers of patients. Further studies need to be done for longer periods in larger groups of patients. Areas for additional research are suggested.

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