Aspects of anaemia management in children with established renal failure (chapter 15)

Despite the universal availability of erythropoietin and intravenous iron, 14% of transplant patients and 30% of dialysis patients have a haemoglobin (Hb) <10.5 g/dl. Only 11% of anaemic transplant patients were receiving erythropoietin. There was a linear relationship between estimated glomerular filtration rate (eGFR) and Hb with the risk of anaemia occurring at a much higher eGFR than would be expected in the chronic kidney disease (CKD) population. There was also a significant association between the use of mycophenolate and anaemia. Around 95% of dialysis patients were receiving erythropoietin and 47% intravenous iron. It is speculated that raising the target Hb for this population to 13 g/dl could shift the whole distribution curve to the left, reducing the proportion with anaemia. Doing this would require careful monitoring to steepen the distribution curve and limit the upper tail if complications of high haematocrits are to be avoided.