In healthy individuals, the kidney accounts for about 50% of the total MCR,23 and it is less than this in patients with renal disease,24 whereas extrarenal elimination (mostly via the liver) does not seem to differ significantly between the two groups.23 However, the situation is made more complex by the fact that GH also exists (reversibly) bound to GHBP, which is decreased in ESRD patients; the relative amounts of bound GH will most likely also correlate with the GH elimination rate. The gene discussed is GHR; the disease is kidney disorder.