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Use of subcutaneous recombinant human erythropoietin in children undergoing continuous cycling peritoneal dialysis
L Sinai-Trieman1, I B Salusky, R N Fine
1Department of Pediatrics, University of California, Los Angeles Center for the Health Sciences.
Insights
Recombinant human erythropoietin (rHuEpo) effectively treats anemia in adolescents with end-stage renal disease, eliminating transfusion dependence. Patients self-administered subcutaneous injections, showing improved hemoglobin and sustained hematocrit levels without antibody formation.
Area of Science:
- Nephrology
- Hematology
Background:
- Anemia is a common complication in patients with end-stage renal disease (ESRD).
- Transfusion dependence is a significant burden for anemic ESRD patients, particularly adolescents.
Purpose of the Study:
- To evaluate the efficacy and safety of recombinant human erythropoietin (rHuEpo) in anemic adolescents with ESRD undergoing peritoneal dialysis.
- To assess the impact of rHuEpo therapy on transfusion requirements and hematocrit levels.
Main Methods:
- Five anemic, transfusion-dependent patients (12-18 years) with ESRD on peritoneal dialysis received self-administered subcutaneous rHuEpo (150 U/kg thrice weekly).
- Hematocrit, hemoglobin, and reticulocyte counts were monitored.
- Dosage was adjusted to maintain hematocrit between 32-38%.
Main Results:
- All patients showed increased reticulocyte count and hemoglobin concentration.
- Hematocrit levels rose to a mean of 33.04% within 3 weeks, eliminating the need for transfusions.
- Four patients eventually required only weekly rHuEpo injections to maintain hematocrit.
- No antibodies to rHuEpo were detected.
- Three patients experienced hypertension exacerbation requiring medication adjustment.
Conclusions:
- rHuEpo is effective in correcting anemia in adolescents with ESRD.
- rHuEpo therapy significantly reduces or eliminates the need for blood transfusions.
- rHuEpo is generally well-tolerated, with manageable side effects like hypertension.
Abstract:
Five anemic, transfusion-dependent patients aged 12 to 18 years, who had end-stage renal disease (mean hematocrit value 22 +/- 0.31%) and were on a regimen of peritoneal dialysis, were treated with recombinant human erythropoietin (rHuEpo), which was self-administered at home by subcutaneous injections thrice weekly at an initial dosage of 150 U/kg. All patients had an increase in the reticulocyte count and hemoglobin concentration, and none required further transfusions. The hematocrit level rose to a mean of 33.04 +/- 1.86% within 3 weeks of rHuEpo therapy, and the dosage was adjusted to keep the hematocrit level between 32% and 38% indefinitely. Currently four of these patients require only one dose a week to sustain the hematocrit level. No antibodies to the rHuEpo were formed. Three patients had an exacerbation of hypertension, which required an adjustment in antihypertensive therapy. No other side effects were noted. The results demonstrate that rHuEpo is effective in correcting the anemia of end-stage renal disease, thereby eliminating the associated clinical symptoms and the need for further blood transfusions.