The rationale for the guideline is that whilst growth is documented in a proportion of those receiving renal replacement therapy (published in the UK Renal Registry report) there is scope for improving identification of growth failure in children at an earlier stage. Identification and treatment of nutritional deficiencies and metabolic abnormalities should be aggressively pursued with respect to linear growth. Recombinant human growth hormone (rhGH) should be considered if there is growth failure despite the treatment of nutritional deficiencies and metabolic abnormalities 20 . Supporting evidence states that response to growth hormone (rhGH) therapy is better if commenced at a younger age.
