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Anemia of chronic renal failure: treatment with erythropoietin
M Navarro1, A Alonso, J M Avilla
1Pediatric Nephrology Division, Hospital Infantil La Paz, Madrid, Spain.
Insights
Recombinant human erythropoietin (rHuEPO) effectively treats anemia in children with end-stage renal failure (ESRF), improving hemoglobin levels and well-being. The treatment showed similar efficacy across conservative, peritoneal dialysis, and hemodialysis groups without impacting renal function.
Area of Science:
- Pediatric Nephrology
- Hematology
- Renal Medicine
Background:
- Children with end-stage renal failure (ESRF) often suffer from anemia, impacting their quality of life.
- Anemia in ESRF is typically treated with erythropoiesis-stimulating agents.
Purpose of the Study:
- To evaluate the efficacy and safety of intravenous recombinant human erythropoietin (rHuEPO) in anemic children with ESRF.
- To assess the impact of rHuEPO on hemoglobin levels, renal function, and overall well-being in this pediatric population.
Main Methods:
- A cohort of 23 anemic children with ESRF (aged 0.1-19.0 years) received intravenous rHuEPO.
- Treatment included children on conservative management, continuous ambulatory peritoneal dialysis (CAPD), and chronic hemodialysis.
- rHuEPO dosage was adjusted weekly to achieve a target hemoglobin of 10-12 g/dl.
Main Results:
- Hemoglobin levels significantly increased from 7.4 +/- 1.3 to 10.7 +/- 1.4 g/dl (p < 0.001) after 4.3 months.
- rHuEPO demonstrated similar efficacy in predialysis, CAPD, and hemodialysis groups.
- No significant changes in estimated glomerular filtration rate (eGFR) were observed in predialysis patients.
- Improvements in appetite, physical activity, and well-being were noted in all children.
- Mild hypertension occurred in four children, serum calcium and aluminum levels increased, with a correlation between aluminum levels and rHuEPO dose.
Conclusions:
- Intravenous rHuEPO is an effective treatment for anemia in pediatric ESRF patients across different management modalities.
- rHuEPO improves hematological parameters and quality of life without adversely affecting renal function.
- Careful monitoring for potential side effects like hypertension and changes in mineral metabolism is recommended.
Abstract:
Twenty-three anemic children with end-stage renal failure (ESRD), aged 0.1-19.0 years (X +/- SD, 8.3 +/- 5.7 years), were treated with intravenous recombinant human erythropoietin (rHuEPO). Eleven were on conservative treatment and their estimated glomerular filtration rate (EGFR) was 11.8 +/- 3.8 ml/min/1.73 m2; 7 were on continuous ambulatory peritoneal dialysis (CAPD) and 5 on chronic hemodialysis. rHuEPO was given once a week in predialysis and CAPD children and thrice weekly in patients on hemodialysis. The initial dose of 50 U/kg/week was increased gradually up to a target hemoglobin of 10-12 g/dl. After 4.3 +/- 1.3 months of treatment, hemoglobin increased from 7.4 +/- 1.3 to 10.7 +/- 1.4 g/dl (p less than 0.001). An hemoglobin concentration of 11.4 +/- 0.9 g/dl was maintained with a rHuEPO dose of 289 +/- 86 U/kg/week. The response was similar in predialysis, CAPD, and hemodialysis children. No change in renal function was observed in predialysis children, EGFR being 11.8 +/- 3.8 and 10.8 +/- 1.7 ml/min/1.73 m2, before and after rHuEPO therapy. All children improved appetite, physical activity, and the sense of well-being. Four developed mild hypertension that was easily controlled with antihypertensive therapy. Heparin dose had to be increased during the hemodialysis sessions to avoid clotting of the filter. Serum calcium increased from 9.9 +/- 0.9 to 10.5 +/- 0.9 mg/dl (p less than 0.001). Serum aluminium levels also increased from 65 +/- 17 to 100 +/- 15 micrograms/l, p less than 0.01. A linear correlation (r = 0.58, p less than 0.01) between aluminium levels and rHuEPO dose was found.(ABSTRACT TRUNCATED AT 250 WORDS)