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Erythropoietin Resistance Index and the Affecting Factors in Children with Peritoneal Dialysis
Ayşe Seda Pınarbaşı1, Ismail Dursun2, Neslihan Günay2
1Pediatric Nephrology, Diyarbakır Children's Hospital, Diyarbakır, Turkey.
Insights
Young age, absence of residual kidney function, frequent hospitalizations, and ACE inhibitor use are key factors contributing to high erythropoietin resistance index (ERI) in pediatric peritoneal dialysis patients. These findings highlight critical areas for optimizing anemia management in this vulnerable population.
Area of Science:
- Pediatric Nephrology
- Hematology
- Dialysis Medicine
Background:
- Anemia is a common complication in children with chronic kidney disease (CKD).
- Erythropoiesis-stimulating agents (ESAs) are standard treatment for anemia in CKD.
- The Erythropoietin Resistance Index (ERI) helps assess response to ESAs, but factors influencing high ERI in pediatric peritoneal dialysis (PD) patients require further investigation.
Purpose of the Study:
- To identify the primary causes of elevated ERI in children undergoing peritoneal dialysis.
- To elucidate the relationship between demographic factors, clinical parameters, and ESA response in pediatric PD patients.
Main Methods:
- A retrospective study included 100 pediatric patients on PD for over one year.
- Data collected included demographics, residual kidney function (RKF), dialysis adequacy, glucose exposure, hospitalization history, and medications.
- Time-averaged laboratory values and ESA doses were used to calculate ERI (U/kg/week/g/dL).
Main Results:
- The mean ERI was 13.01 ± 7.52 U/kg/week/g/dL.
- Younger children (<5 years) exhibited significantly higher ERI values, requiring double the ESA dose compared to older children (>10 years).
- Absence of RKF, increased hospitalizations, and Angiotensin-Converting Enzyme Inhibitor (ACEI) use were associated with higher ERI.
Conclusions:
- Young age is the most significant factor associated with high ERI in pediatric PD patients.
- Reduced RKF, frequent hospitalizations, and ACEI use are also critical variables impacting ESA responsiveness.
- These findings underscore the need for tailored anemia management strategies in young PD patients, considering these contributing factors.
Background:
Erythropoiesis-stimulating agents (ESAs) are used to treat anemia in CKD. Erythropoietin resistance index (ERI) is a useful tool used to evaluate the response to ESAs. In this study, we aimed to evaluate the causes of high ERI in children undergoing peritoneal dialysis (PD).
Method:
Patients who had been on PD for at least 1 year were included in this retrospective study. Demographic characteristics, residual kidney function (RKF), adequacy of dialysis, peritoneal glucose exposure, the number and reason for hospitalization, and medications were recorded. Anemia and laboratory parameters that may affect anemia were noted by taking the average of laboratory values in the last follow-up year (time-averaged). The weekly ESA dose was proportioned to the annual average hemoglobin value and body weight to calculate the ERI in terms of U/kg/week/g/dL.
Results:
A total of 100 patients were included in the study. The mean ESA dose and ERI value were 119.8 ± 66.22 U/kg/week and 13.01 ± 7.52 U/kg/week/g/dL, respectively. It was determined that the patients <5 years of age have very high ERI value, and these patients need 2 times more ESA than those >10 years of age. Absence of RKF, large number of hospitalization, and ACEI use were also found to affect the ERI value negatively.
Conclusion:
We demonstrate that the most important factor affecting ERI value is young age. We also reveal that absence of RKF, large number of hospitalization, and ACEI use are also important variables affecting the ERI value.
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