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Am J Physiol Regul Integr Comp Physiol 276: R929-R934, 1999;
0363-6119/99 $5.00
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Vol. 276, Issue 4, R929-R934, April 1999

Insulin-like growth factor I improves renal function in patients with end-stage chronic renal failure

Anitha Vijayan, Samuel C. Franklin, Terry Behrend, Marc R. Hammerman, and Steven B. Miller

George M. O'Brien Kidney and Urologic Diseases Center, Renal Division, Department of Internal Medicine and Cell Biology and Physiology, Washington University School of Medicine, St. Louis, Missouri 63110

There is no pharmacological treatment to increase the glomerular filtration rate in end-stage renal disease (ESRD). The administration of 100 µg/kg of insulin-like growth factor (IGF) I twice a day to patients with ESRD increases inulin clearance. However, its effect is short-lived and IGF-I has major side effects when given this way. To assess whether the use of a lower intermittent dose of IGF-I would effect sustained improved function with tolerable side effects we performed 1) a prospective open-labeled 24-day trial in which we enrolled five patients and 2) a 31-day randomized, double-blinded, placebo-controlled trial in which we enrolled 10 patients. Patients with ESRD [creatinine clearance of <15 ml · min-1 · (1.73 m2)-1] and scheduled to initiate renal replacement therapy received subcutaneous IGF-I, 50 µg · kg-1 · day-1, or vehicle. Treatment with IGF I resulted in significantly increased glomerular filtration rates (inulin clearances) during the 3rd and 4th wk of therapy in both prospective and double-blinded studies. Vehicle had no effect. No patient required discontinuation of drug secondary to side effects. We conclude that IGF-I effects sustained improvement of renal function (clearances comparable to those generally achieved by dialysis) in patients with ESRD and is well tolerated.

dialysis; glomerular filtration rate; growth factor; middle molecules


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