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The effects of recombinant human erythropoietin on growth and nutritional status
1Division of Nephrology, Children's Hospital, Boston, Massachusetts 02115, USA.
Insights
Recombinant human erythropoietin (rhuEPO) improved weight in children with chronic renal failure (CRF) but did not significantly enhance nutritional status or height. Correction of anemia with rhuEPO has not yet been shown to improve growth in pediatric CRF patients.
Area of Science:
- Pediatric Nephrology
- Hematology
- Pediatric Endocrinology
Background:
- Chronic renal failure (CRF) in children presents significant morbidity, including growth retardation.
- Anemia is a major complication of CRF, impacting overall health and development.
- Recombinant human erythropoietin (rhuEPO) is available for treating anemia in pediatric CRF patients.
Purpose of the Study:
- To evaluate the impact of rhuEPO treatment on the nutritional status and growth of children with CRF.
- To determine the contribution of anemia correction to growth in pediatric CRF.
- To review existing literature and clinical trial data on rhuEPO use in pediatric CRF.
Main Methods:
- Review of scientific literature on rhuEPO in pediatric CRF.
- Analysis of data from a US Phase III double-blind, placebo-controlled study in pediatric dialysis patients.
- Assessment of nutritional intake, anthropometric measures, weight, and height standard deviation scores.
Main Results:
- rhuEPO treatment led to subjective appetite increases but no consistent improvements in dietary intake or anthropometric measures.
- Children gained weight, but this was not generally associated with increased weight standard deviation scores.
- Some children showed improved growth velocity, but improvements in height standard deviation scores were infrequent.
Conclusions:
- Correction of anemia with rhuEPO has not demonstrated a significant improvement in the growth of children suffering from CRF.
- Further research is needed to understand the multifactorial causes of growth retardation in pediatric CRF.
- While rhuEPO addresses anemia, its direct impact on linear growth in pediatric CRF remains limited.
Abstract:
The availability of recombinant human erythropoietin (rhuEPO) has dramatically improved the care of children with chronic renal failure (CRF). Its use provides the opportunity to determine the relative contribution of anemia to the morbidity of CRF. Growth retardation, one of the most significant complications of CRF in children, is the consequence of several inter-related processes, including decreased protein and energy intake, metabolic bone disease, endocrine abnormalities, and anemia. The literature on the use of rhuEPO in children and data from a United States phase III double-blind, placebo-controlled study of rhuEPO in pediatric dialysis patients are reviewed to determine the effect of rhuEPO treatment on the nutritional status and growth of children with CRF. Despite subjective increases in appetite, there were no consistent improvements in dietary intake or anthropometric measures observed during rhuEPO treatment. Children gained weight during rhuEPO treatment; however, this was not generally associated with increased weight standard deviation scores. There was an improvement in growth velocity in some children; however, improvements in height standard deviation scores were infrequently seen. On review of the available literature, correction of anemia with rhuEPO has not been shown to improve the growth of children with CRF.