Erythropoietin associated hypertension among pediatric dialysis patients

The major side effect of rHuEPO is hypertension, which is reported to occur in 10-75% of adult patients. The aim of the present study is to evaluate the effect of rHuEPO on blood pressure in pediatric dialysis patients. Nine CAPD patients (mean age 7.4 +/- 3.6 years) and fourteen HD patients (mean age 13.8 +/- 5.5 years) were treated with rHuEPO. The hematocrits increased significantly from 20.7 +/- 1.8 to 28.3 +/- 4.1 in HD patients and from 19.7 +/- 2.9 to 26.7 +/- 4.4 in CAPD patients. The final maintenance dose required to correct the anemia was 47.6 +/- 11.7 units/kg/week for CAPD patients and 122.6 +/- 75.2 U/kg/week foe HD patients. Six (66.6%) out of nine CAPD patients, and five (35.7%) of fourteen HD patients developed or worsened hypertension. Younger CAPD patients tended to develop hypertension. Correction of anemia was poor in two hypertension-exacerbated patients, since rHuEPO dose increase was withheld for fear of aggravating hypertension. A four-year-old girl developed hypertensive encephalopathy after 13 months of rHuEPO therapy. No difference was observed in plasma level of aldosterone or plasma renin activity. Hypertension is observed frequently among pediatric dialysis patients treated with rHuEPO therapy. Careful monitoring and management of hypertension is required, especially in the first three months of rHuEPO therapy.