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Renal function in predialysis children with chronic renal failure treated with erythropoietin
1Division of Pediatric Nephrology, Children's Hospital Heidelburg, Germany.
Insights
Long-term erythropoietin (EPO) treatment in anemic children with chronic kidney disease did not accelerate renal function decline. Instead, EPO therapy appeared to delay the deterioration of kidney function in most pediatric patients.
Area of Science:
- Pediatric Nephrology
- Renal Medicine
- Hematology
Background:
- Anemia is common in children with chronic kidney disease (CKD).
- Erythropoietin (EPO) therapy is used to treat anemia in CKD patients.
- The long-term effects of EPO on renal function in pediatric CKD are not fully understood.
Purpose of the Study:
- To evaluate the impact of long-term human recombinant erythropoietin (EPO) administration on renal function in anemic children with predialysis chronic renal failure.
- To determine if EPO therapy accelerates or delays the rate of renal function deterioration.
Main Methods:
- A cohort of 11 anemic children (aged 1.4-17.2 years) with predialysis CKD were monitored for a mean of 31 months during EPO treatment.
- Renal function was assessed by calculating the slope of reciprocal serum creatinine values over periods before and during EPO therapy.
- Hemoglobin levels and EPO dosage were recorded.
Main Results:
- Mean hemoglobin levels increased from 8.1 to 11.1 g/dl during EPO therapy.
- The rate of renal function deterioration, measured by the change in the slope of reciprocal serum creatinine, showed a non-significant trend towards improvement (mean change from -0.0521 to -0.0299).
- Individual slopes improved in 8 out of 11 patients.
Conclusions:
- Long-term administration of EPO in children with predialysis chronic renal failure is generally not associated with accelerated renal function deterioration.
- EPO therapy may potentially delay the progression of renal function decline in this pediatric population.
- Further research is warranted to confirm these findings and elucidate the mechanisms involved.
Abstract:
To assess the effect of long-term administration of human recombinant erythropoietin (EPO) on renal function, 11 anemic children aged 1.4-17.2 years were followed for 10-61 (mean 31) months on treatment. During EPO therapy the mean hemoglobin rose from 8.1 to 11.1 g/dl at the last observation. The final maintenance dose ranged between 70 and 300 U/kg per week. The rate of deterioration of renal function was calculated by comparing the slope of the regression lines of reciprocal serum creatinine values (SCr) derived from a mean of 20 values per patient obtained over 8-50 (mean 29) months before and a mean of 24 SCR values during EPO therapy. The individual slopes improved after initiation of EPO therapy in all but 3 patients, but the mean change of slope (from -0.0521 to -0.0299) was not significant. The study suggests that in most children with predialysis chronic renal failure long-term administration of EPO is not associated with accelerated deterioration but rather with delayed deterioration of renal function.