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Low-dose erythropoietin is effective and safe in children on continuous ambulatory peritoneal dialysis
F Yalçinkaya1, N Tümer, N Cakar
1Department of Pediatric Nephrology, Ankara University Faculty of Medicine, Turkey.
Insights
High-dose erythropoietin (rHuEPO) therapy in children on dialysis can worsen hypertension. Gradual hematocrit increases with lower rHuEPO doses are safer for managing blood pressure in these patients.
Area of Science:
- Nephrology
- Pediatric Nephrology
- Pharmacology
Background:
- Hypertension is a significant complication of erythropoietin (rHuEPO) therapy in dialysis patients.
- Anemia is common in children undergoing continuous ambulatory peritoneal dialysis (CAPD).
Purpose of the Study:
- To evaluate the effect of two different subcutaneous rHuEPO dosage regimens on blood pressure (BP) in anemic children on CAPD.
- To identify risk factors for hypertension development or worsening during rHuEPO therapy.
Main Methods:
- 20 anemic children on CAPD were randomized into two groups.
- Group 1 received rHuEPO 50 U/kg once weekly; Group 2 received 150 U/kg weekly (50 U/kg three times weekly).
- Blood pressure and hematocrit levels were monitored; antihypertensive medication adjustments were recorded.
Main Results:
- Group 2 showed a rapid hematocrit increase and a significant rise in mean arterial BP.
- All hypertensive patients in Group 2 required increased antihypertensive therapy; one normotensive patient needed initiation.
- No patients in Group 1 required changes in antihypertensive medication, despite a gradual hematocrit increase.
Conclusions:
- Pre-existing hypertension and higher rHuEPO doses are key risk factors for hypertension in pediatric CAPD patients.
- Gradual hematocrit elevation using low-dose rHuEPO effectively avoids severe hypertension development.
- Careful rHuEPO dosing is crucial for managing blood pressure in anemic children on CAPD.
Abstract:
Hypertension is one of the most important complications of erythropoietin (rHuEPO) therapy in dialysis patients. In this study, the effect of two different dosage regiments of subcutaneous rHuEPO on blood pressure [BP] was evaluated in 20 anemic children on continuous ambulatory peritoneal dialysis (CAPD). Patients were randomized to receive rHuEPO 50 U/kg, either once a week (group 1, 50 U/kg per week) or three times a week (group 2, 150 U/kg per week). At the beginning of the study, 8 patients in group 1 and 8 patients in group 2 were on antihypertensive therapy. In group 1, the hematocrit increased gradually and significantly from 18.98% +/- 1.79% to 30.1% +/- 1.62% after 6 months, while in group 2 it rapidly increased from 19.53% +/- 1.86% to 32.4% +/- 1.11% after 3 months. A significant increase in the mean arterial BP was observed in group 2. Antihypertensive therapy had to be increased in all of the 8 previously hypertensive patients and had to be initiated in 1 of the 2 originally normotensive patients in the same group. None of the patients in group 1 required a change in antihypertensive medication. We conclude that during treatment with rHuEPO pre-existing hypertension and the dose of rHuEPO are the most important risk factors for the development or worsening of hypertension in children on CAPD, and gradual elevation of hematocrit by low-dose rHuEPO avoids the development of severe hypertension.