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Effect of hyperparathyroidism on response to erythropoietin in children on dialysis
1Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, USA.
Insights
Recombinant human erythropoietin (rHuEPO) effectively treats anemia in pediatric dialysis patients. Higher doses may be needed for those with significantly elevated parathyroid hormone (PTH) levels.
Area of Science:
- Pediatric Nephrology
- Hematology
- Renal Medicine
Background:
- Anemia is a common complication in children and adolescents with end-stage renal disease (ESRD).
- Frequent blood transfusions were historically required for transfusion-dependent ESRD patients.
- Recombinant human erythropoietin (rHuEPO) offers a therapeutic alternative for managing anemia in ESRD.
Purpose of the Study:
- To evaluate the efficacy and safety of rHuEPO in pediatric patients with ESRD.
- To determine the optimal rHuEPO dosage for achieving target hematocrit levels.
- To investigate factors influencing rHuEPO response, including parathyroid hormone (PTH) levels.
Main Methods:
- Prospective study of 17 pediatric ESRD patients receiving rHuEPO (50 units/kg thrice weekly).
- Patients were categorized into hemodialysis (HD) and peritoneal dialysis (PD) groups.
- Serial monitoring of hematocrit, iron indices, blood pressure, and biochemical parameters including intact PTH.
Main Results:
- rHuEPO therapy eliminated the need for frequent transfusions in all patients.
- 11 out of 17 patients achieved the target hematocrit of 30%-33%.
- Patients with pre-therapy intact PTH levels >400 pg/mL required higher rHuEPO doses (120-130 units/kg thrice weekly) to reach target hematocrit.
Conclusions:
- rHuEPO is effective in treating anemia in most pediatric dialysis patients at a dose of 50 units/kg thrice weekly.
- Markedly elevated serum PTH levels are associated with a reduced response to standard rHuEPO doses.
- Higher rHuEPO dosages may be necessary for pediatric dialysis patients with significantly elevated PTH concentrations.
Abstract:
The response to recombinant human erythropoietin (rHuEPO), 50 units/kg thrice weekly, was studied prospectively in 17 children and adolescents with end-stage renal disease who were either transfusion dependent or had hematocrits < 25%. For convenience, rHuEPO was given intravenously to 12 hemodialysis (HD) patients and subcutaneously to 5 peritoneal dialysis (PD) patients. Blood pressure, hematocrit, iron indices, and serum potassium, calcium, phosphorus, alkaline phosphatase, urea nitrogen, and intact parathyroid hormone (PTH) were monitored serially. When serum ferritin was < 100 ng/ ml during therapy, 6 patients received iron supplementation. rHuEPO therapy eliminated frequent transfusions in all patients; 11 of 17 patients reached the target hematocrit of 30%-33% by week 16 of rHuEPO, 50 units/kg thrice weekly. The 5 PD patients treated subcutaneously reached target at week 6 +/- 1; 6 HD patients treated intravenously reached target at week 11 +/- 3; 6 additional HD patients never reached target at this dose; 5 of 6 had pre-rHuEPO serum PTH levels >400 pg/ml, significantly higher than those of the other patients (P < 0.005); 3 of 6 later reached a hematocrit of 30%-33% after the rHuEPO dose was increased to 120-130 units/kg thrice weekly. We conclude that most pediatric dialysis patients can be treated successfully with rHuEPO, 50 units/kg thrice weekly, unless the serum PTH concentration is markedly elevated, in which case a higher dose is likely to be needed.
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