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Recombinant human erythropoietin therapy in pediatric patients receiving long-term peritoneal dialysis
B A Warady1, R J Sabath, C A Smith
1Nephrology Section, Children's Mercy Hospital, Kansas City, Missouri 64108.
Insights
Subcutaneous recombinant human erythropoietin (r-HuEPO) therapy significantly improved hematocrit and exercise capacity in pediatric patients on peritoneal dialysis. This anemia treatment reduced transfusion needs and enhanced physical function without altering dietary intake.
Area of Science:
- Pediatric Nephrology
- Hematology
- Exercise Physiology
Background:
- Anemia is a common complication in pediatric patients undergoing long-term peritoneal dialysis.
- Reduced erythropoiesis and iron deficiency contribute to anemia in this population.
- Anemia negatively impacts quality of life and exercise capacity in children with chronic kidney disease.
Purpose of the Study:
- To evaluate the efficacy of subcutaneous recombinant human erythropoietin (r-HuEPO) therapy in addressing anemia.
- To assess the impact of r-HuEPO on exercise capacity in pediatric patients on peritoneal dialysis.
- To investigate changes in dietary intake and transfusion requirements during r-HuEPO treatment.
Main Methods:
- Nine pediatric patients on long-term peritoneal dialysis received subcutaneous r-HuEPO (50 units/kg) twice weekly.
- Hematological parameters (hematocrit) and blood transfusion requirements were monitored.
- Graded exercise testing (peak oxygen consumption, anaerobic threshold) was performed before and during therapy.
- Dietary intake (caloric and protein) was assessed.
- A control group of healthy children was used for exercise testing comparisons.
Main Results:
- Hematocrit significantly increased from 21.9% to 31.3% after 7.9 weeks of therapy (P < 0.001), further rising to 33.2% with once-weekly dosing.
- Blood transfusion requirements decreased from 0.5 to 0.05 transfusions per patient-month (P < 0.01).
- Peak oxygen consumption increased from 17.8 to 24.0 ml/kg/min (P < 0.01), and oxygen consumption at anaerobic threshold rose from 13.1 to 17.1 ml/kg/min (P < 0.02).
- Treadmill exercise duration increased significantly (P < 0.001).
- No significant changes in caloric or protein intake were observed, despite subjective appetite improvement.
Conclusions:
- Subcutaneous r-HuEPO therapy is effective in correcting anemia in pediatric patients on long-term peritoneal dialysis.
- r-HuEPO treatment significantly improves exercise capacity and reduces the need for blood transfusions.
- The benefits on hematological status and exercise performance occur without significant alterations in dietary intake.
Abstract:
We evaluated the impact of (s.c.) recombinant human erythropoietin (r-HuEPO) therapy on the hematological status, exercise capacity, and dietary intake of nine pediatric patients (mean age 12.4 +/- 3.2 years) receiving long-term peritoneal dialysis. Five children without medical illness served as controls for the exercise testing portion of the study. Following 7.9 +/- 2.8 weeks of twice weekly r-HuEPO (50 units/kg per dose), the hematocrit increased from 21.9 +/- 3.5% to 31.3 +/- 2.5% (P less than 0.001). A further increase to 33.2 +/- 3.0% occurred after 2 months of once weekly therapy. The blood transfusion requirement decreased from 0.5 transfusions per patient-month to 0.05 transfusions per patient-month (P less than 0.01). Graded exercise testing demonstrated an increase in peak oxygen consumption from 17.8 +/- 5.2 to 24.0 +/- 7.6 ml/kg per min (P less than 0.01). The oxygen consumption at anaerobic threshold increased from 13.1 +/- 3.9 to 17.1 +/- 3.5 ml/kg per min (P less than 0.02). Treadmill time increased from 5.3 +/- 1.2 to 7.5 +/- 1.3 min (P less than 0.001). In each case, the percentage improvement was significantly greater than the improvement seen in the control population. Dietary evaluation revealed no significant change in caloric or protein intake, despite a subjectively improved appetite. r-HuEPO, given by the s.c. route, corrects the anemia and improves the exercise capacity of pediatric patients receiving long-term peritoneal dialysis.