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ENDOCRINE AND GROWTH ABNORMALITIES IN CHILDREN WITH KIDNEY FAILURE ON MAINTENANCE HEMODIALYSIS - EXPERIENCE OF A
R Steflea1,2, R F Stroescu1,2, M Gafencu1,2
1"Victor Babes" University of Medicine and Pharmacy, XI Pediatrics, Timișoara, Romania.
Insights
Pediatric patients with end-stage renal disease (ESRD) experience endocrine issues like anemia and mineral imbalances. Individualized, multidisciplinary care is crucial for managing these complex conditions in children undergoing hemodialysis.
Area of Science:
- Pediatric Nephrology
- Endocrinology
- Mineral Metabolism
Background:
- Endocrine disturbances are complex in pediatric kidney disease.
- Longitudinal follow-up is essential for monitoring growth and puberty in these patients.
Observation:
- A prospective study involved ten pediatric patients with end-stage renal disease (ESRD) on hemodialysis.
- Data collected included anemia, inflammation, and mineral metabolism parameters.
- Erythropoietin doses exceeded guidelines, with initial hemoglobin levels below normal.
Findings:
- Hemoglobin levels showed a slight increase over three years.
- Vitamin D levels varied widely, indicating poor control of mineral bone disease.
- Kidney function loss correlates with impaired calcium-phosphorus balance, anemia, and growth/pubertal delays.
Implications:
- This study underscores the need for tailored treatment strategies for pediatric ESRD.
- A multidisciplinary approach is vital for optimizing endocrine management in these children.
- Further research into individualized therapies can improve outcomes for children with chronic kidney disease.
Abstract:
The underlying mechanisms for endocrine disturbances in patients with kidney alterations are complex.
Aim:
To provide better longitudinal follow-up of children, especially to check their progress through puberty.
Material And Methods:
A prospective study was conducted at the "Louis Turcanu" Emergency Hospital for Children in Timisoara, Romania during 01.01.2022- 31.12.2024. The study population included ten pediatric patients with end stage renal disease (ESRD) on hemodialysis. Data were collected from the electronic medical records and included demographic information and relevant laboratory parameters, which reflect the patients' anemia status, inflammation, mineral metabolism and other endocrine abnormalities.
Results:
Erythropoietin doses ranged from 87 to 176 units/kg once a week at the beginning of our study, higher than guidelines recommendations. Most patients presented with hemoglobin levels below the normal range which slightly increased over the 3 years period. Vitamin D levels ranged from 8.1 to 55.8 ng/mL. These resulted in a poor control of the mineral bone disease associated with kidney failure.
Conclusions:
The loss of kidney function is associated with an impaired control of phosphor-calcium balance, and anemia, growth and pubertal delay in children. This study highlights the need for individualized treatment plans and a multidisciplinary approach in pediatric patients with ESRD.
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