From the Guidelines
Sermorelin should be used with caution in patients with impaired renal function, as it may require dose adjustments and close monitoring of kidney function. When considering the use of sermorelin, a growth hormone-releasing hormone (GHRH) analogue, in patients with kidney disease, it is essential to weigh the potential benefits against the risks. The primary concern is that decreased renal function can lead to reduced clearance of the drug, potentially causing accumulation and increasing the risk of side effects such as injection site reactions, headaches, hyperglycemia, and fluid retention 1.
Key Considerations
- Sermorelin's impact on renal function in patients with chronic kidney disease (CKD) has been studied, and while RCTs have not shown adverse effects of growth hormone on renal function in pediatric patients with nondialysis CKD, close monitoring is still recommended 1.
- Anecdotal reports of increases in serum creatinine levels suggest the need for vigilant monitoring of renal function, particularly in patients with CKD stage 3–4, where monitoring at 3-month intervals is advised 1.
- The decision to use sermorelin in patients with impaired renal function should be made on a case-by-case basis, considering the severity of renal impairment and the potential for altered growth hormone metabolism, which could lead to unpredictable responses to therapy.
Clinical Approach
- For patients with mild to moderate renal impairment, close monitoring of kidney function during treatment is crucial.
- In cases of severe renal impairment or end-stage renal disease, alternative treatments should be considered, as the risks associated with sermorelin may outweigh the benefits.
- A comprehensive renal function assessment should be performed before initiating sermorelin in patients with kidney issues, and the treatment plan should be individualized based on the severity of renal impairment.
From the Research
Sermorelin and Kidney Function
There are limited studies directly addressing the concerns of sermorelin, a growth hormone-releasing hormone (GHRH) analogue, and impaired renal function. However, research on growth hormone (GH) and its effects on the kidneys can provide some insights:
- Growth hormone affects renal function and kidney growth, increasing glomerular filtration rate (GFR) and renal plasma flow (RPF) in GH-deficient and normal adults 2.
- The GH/IGF-1 system regulates various renal functions, including glomerular hemodynamics, renal gluconeogenesis, and tubular handling of sodium, water, phosphate, and calcium 3, 4.
- Excess GH can have deleterious effects on kidney health, including glomerular hyperfiltration, renal hypertrophy, and glomerulosclerosis, as observed in animal studies and acromegalic patients 3, 4.
- Chronic kidney disease (CKD) is characterized by abnormalities in GH and IGF-I signal transduction, which may lead to growth retardation and disease progression 5.
- Recombinant human GH (rhGH) therapy has been used in children with short stature, including those with CKD, without consistent changes in kidney function, although long-term effects need further evaluation 2, 4.
Sermorelin-Specific Considerations
- Sermorelin, as a GHRH analogue, stimulates growth hormone secretion from the anterior pituitary, which may indirectly affect kidney function 6.
- There is no direct evidence on the effects of sermorelin on impaired renal function, but its use may be considered in the context of GH's effects on the kidneys, as discussed above.
- The safety and efficacy of sermorelin in patients with impaired renal function would require further investigation, considering the potential risks and benefits of GH therapy in this population 3, 4.