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Anemia in children with chronic kidney disease

Meredith A Atkinson1, Susan L Furth

  • 1Division of Pediatric Nephrology, Johns Hopkins University School of Medicine, 200 N. Wolfe Street, Room 3064, Baltimore, MD 21287, USA. matkins3@jhmi.edu

Nature Reviews. Nephrology
|September 7, 2011
PubMed

Insights

Anemia in children with chronic kidney disease (CKD) is primarily caused by erythropoietin deficiency and iron issues. Erythropoietin-stimulating agents (ESAs) treat this, but optimal hemoglobin targets and risks in children require further study.

Area of Science:

  • Pediatric Nephrology
  • Hematology
  • Internal Medicine

Background:

  • Anemia is a frequent comorbidity in pediatric chronic kidney disease (CKD), linked to increased morbidity, mortality, cardiovascular risks, and reduced quality of life.
  • Key causes of anemia in pediatric CKD include erythropoietin deficiency and iron dysregulation, such as iron deficiency and iron-restricted erythropoiesis.

Purpose of the Study:

  • To review the management of anemia in children with CKD.
  • To highlight differences in erythropoietin-stimulating agent (ESA) dosing between pediatric and adult populations.
  • To discuss the challenges of hyporesponsiveness to ESA therapy and the ongoing debate regarding appropriate hemoglobin targets in children.

Main Methods:

  • Literature review focusing on anemia in pediatric CKD.
  • Analysis of factors contributing to anemia, including hormonal and iron-related aspects.
  • Examination of treatment strategies, particularly erythropoietin-stimulating agents (ESAs) and iron supplementation.

Main Results:

  • Anemia in pediatric CKD has multifactorial causes, with erythropoietin deficiency and iron dysregulation being primary drivers.
  • Erythropoietin-stimulating agents (ESAs) are effective but exhibit different dose requirements in children versus adults.
  • Hyporesponsiveness to ESAs is a significant issue in pediatric CKD, and the safety of escalating doses for higher hemoglobin targets in children remains unproven.

Conclusions:

  • Effective management of anemia in pediatric CKD requires addressing both erythropoietin deficiency and iron status.
  • Further randomized, controlled studies are essential to determine the benefits and risks of normalizing hemoglobin levels in anemic children with CKD.

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