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In prepubertal children with advanced CKD and severe growth retardation, GH administration has shown significant benefits, leading to increased serum IGF-1 levels.97 However, despite improved growth in children treated with GH and the non-apparent progression of renal damage, bone maturation seems to be unaffected despite of the increased plasma IGF-1 levels after 6 months, maybe due to the concomitant decrease of IGFBP-1 and increase of IGFBP-3, which occurred in a lower extent that the IGF-1 changes.98 In the same way, circulating levels of IGF-1 are not correlated with bone formation parameters in non-dialysis CKD patients, which apparently excludes a role of the IGF-1 in bone turnover.99 Recent studies have demonstrated that low serum IGF-1 levels are associated with lower weight and bone mineral density in pediatric CKD patients.100 Importantly, a combination of recombinant GH and IGF-1 has been found to be more effective in preventing growth retardation than GH alone, suggesting an impaired response to the GH effect on IGF-1 stimulation.101 In a study of young rats with renal insufficiency, despite having similar serum GH levels, exhibited lower IGF-1 concentrations, which may contribute to bone growth retardation