For a study, researchers sought to look into the age at which estrogen replacement treatment should be started to help girls with growth retardation who have chronic kidney disease (CKD) reach near-normal Final Height (FH). As determined by clinical and laboratory investigations, this open-label, quasi-experimental designed, and matched controlled clinical research was conducted on CKD females with low stature, later puberty onset, or delayed puberty. Growth hormone (GH) and Ethinyl estradiol (EE) were administered to participants in groups 1 and 2. EE was given to groups 1 and 2 at 11 and 13, respectively. Patients who agreed to wait until they were 15 years old before beginning GH or EE were chosen for Group 3. The age at which EE was initiated impacted FH, GH therapy results, bone density, and calcium profile. In total, 16, 22, and 21 patients from groups 1, 2, and 3 were examined. Between the 3 groups, there was no discernible difference in mean mid-parental height (MPH). Compared to group 3, GH treatment significantly improved mean FH in groups 1 and 2 (β=-4.29, P<0.001). Additionally, multivariable backward linear regression showed a strong negative correlation between FH and age of EE initiation (β= 0.26, P<0.001). Following GH and EE medication, mean PTH, mean femoral and mean lumbar bone densities improved considerably (P<0.001). To increase the financial efficiency of GH therapy, we advise commencing EE in CKD small stature girls at age 11 who show no clinical or biochemical signs of sexual maturity.