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Prevalence and predictors of the sub-target Hb level in children on dialysis

Karlijn J van Stralen1, Leah Krischock, Franz Schaefer

  • 1Department of Medical Informatics, University of Amsterdam, Amsterdam, The Netherlands. K.J.vanStralen@amc.uva.nl

Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association
|June 29, 2012
PubMed

Insights

Sub-target hemoglobin levels are common in pediatric dialysis patients despite erythropoiesis-stimulating agent (ESA) use. Factors like age, dialysis type, and parathyroid hormone (PTH) influence anemia management in children.

Area of Science:

  • Pediatric Nephrology
  • Hematology
  • Renal Disease Management

Background:

  • Anemia is a frequent comorbidity in pediatric end-stage renal disease (ESRD).
  • Effective anemia management is crucial for improving outcomes in children with ESRD.

Purpose of the Study:

  • To determine the prevalence of sub-target hemoglobin (Hb) levels in European children undergoing dialysis.
  • To identify factors associated with low Hb levels in this pediatric population.

Main Methods:

  • Utilized data from the ESPN/ERA-EDTA registry, including 2351 children (1 month-18 years) and 5546 measurements from 19 countries.
  • Analyzed Hb levels in relation to age, dialysis modality, underlying renal diagnosis, ferritin, parathyroid hormone (PTH), and blood pressure (BP).

Main Results:

  • Mean Hb was 10.8 g/dL; 11.2-11.4% of patients were below target thresholds (8.0-8.5 g/dL).
  • Erythropoiesis-stimulating agent (ESA) use was high (91.2%). Hb increased with age and was higher in peritoneal dialysis vs. hemodialysis.
  • Congenital anomalies correlated with higher Hb; cystic diseases/metabolic disorders with lower Hb. Optimal ferritin: 25-50 ng/mL. Weak inverse PTH-Hb association. Elevated systolic BP z-score in sub-target Hb.

Conclusions:

  • Sub-target Hb levels persist in pediatric dialysis patients despite near-universal ESA treatment, suggesting potential under-dosing.
  • Optimal ferritin levels may be lower in children (25-50 ng/mL) than adults.
  • Dialysis modality and elevated PTH are risk factors for sub-target Hb in children.
Abstract

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