Management of anemia in children receiving chronic peritoneal dialysis

TY - JOUR

T1 - Management of anemia in children receiving chronic peritoneal dialysis

AU - Borzych-Duzalka, Dagmara

AU - Bilginer, Yelda

AU - Ha, Il Soo

AU - Bak, Mustafa

AU - Rees, Lesley

AU - Cano, Francisco

AU - Munarriz, Reyner Loza

AU - Chua, Annabelle

AU - Pesle, Silvia

AU - Emre, Sevinc

AU - Urzykowska, Agnieszka

AU - Quiroz, Lily

AU - Ruscasso, Javier Darío

AU - White, Colin

AU - Pape, Lars

AU - Ramela, Virginia

AU - Printza, Nikoleta

AU - Vogel, Andrea

AU - Kuzmanovska, Dafina

AU - Simkova, Eva

AU - Müller-Wiefel, Dirk E

AU - Sander, Anja

AU - Warady, Bradley A

AU - Schaefer, Franz

AU - International Pediatric Peritoneal Dialysis Network (IPPN) Registry

AU - Kemper, Markus Josef

PY - 2013/3/1

Y1 - 2013/3/1

N2 - Little information exists regarding the efficacy, modifiers, and outcomes of anemia management in children with CKD or ESRD. We assessed practices, effectors, and outcomes of anemia management in 1394 pediatric patients undergoing peritoneal dialysis (PD) who were prospectively followed in 30 countries. We noted that 25% of patients had hemoglobin levels below target (<10 g/dl or <9.5 g/dl in children older or younger than 2 years, respectively), with significant regional variation; levels were highest in North America and Europe and lowest in Asia and Turkey. Low hemoglobin levels were associated with low urine output, low serum albumin, high parathyroid hormone, high ferritin, and the use of bioincompatible PD fluid. Erythropoiesis-stimulating agents (ESAs) were prescribed to 92% of patients, and neither the type of ESA nor the dosing interval appeared to affect efficacy. The weekly ESA dose inversely correlated with age when scaled to weight but did not correlate with age when normalized to body surface area. ESA sensitivity was positively associated with residual diuresis and serum albumin and inversely associated with serum parathyroid hormone and ferritin. The prevalence of hypertension and left ventricular hypertrophy increased with the degree of anemia. Patient survival was positively associated with achieved hemoglobin and serum albumin and was inversely associated with ESA dose. In conclusion, control of anemia in children receiving long-term PD varies by region. ESA requirements are independent of age when dose is scaled to body surface area, and ESA resistance is associated with inflammation, fluid retention, and hyperparathyroidism. Anemia and high ESA dose requirements independently predict mortality.

AB - Little information exists regarding the efficacy, modifiers, and outcomes of anemia management in children with CKD or ESRD. We assessed practices, effectors, and outcomes of anemia management in 1394 pediatric patients undergoing peritoneal dialysis (PD) who were prospectively followed in 30 countries. We noted that 25% of patients had hemoglobin levels below target (<10 g/dl or <9.5 g/dl in children older or younger than 2 years, respectively), with significant regional variation; levels were highest in North America and Europe and lowest in Asia and Turkey. Low hemoglobin levels were associated with low urine output, low serum albumin, high parathyroid hormone, high ferritin, and the use of bioincompatible PD fluid. Erythropoiesis-stimulating agents (ESAs) were prescribed to 92% of patients, and neither the type of ESA nor the dosing interval appeared to affect efficacy. The weekly ESA dose inversely correlated with age when scaled to weight but did not correlate with age when normalized to body surface area. ESA sensitivity was positively associated with residual diuresis and serum albumin and inversely associated with serum parathyroid hormone and ferritin. The prevalence of hypertension and left ventricular hypertrophy increased with the degree of anemia. Patient survival was positively associated with achieved hemoglobin and serum albumin and was inversely associated with ESA dose. In conclusion, control of anemia in children receiving long-term PD varies by region. ESA requirements are independent of age when dose is scaled to body surface area, and ESA resistance is associated with inflammation, fluid retention, and hyperparathyroidism. Anemia and high ESA dose requirements independently predict mortality.

KW - Adolescent

KW - Anemia

KW - Child

KW - Child, Preschool

KW - Female

KW - Hematinics

KW - Hemoglobins

KW - Humans

KW - Infant

KW - Infant, Newborn

KW - Logistic Models

KW - Male

KW - Peritoneal Dialysis

KW - Prevalence

KW - Prospective Studies

KW - Renal Insufficiency, Chronic

KW - Survival Analysis

KW - Treatment Outcome

KW - Young Adult

U2 - 10.1681/ASN.2012050433

DO - 10.1681/ASN.2012050433

M3 - SCORING: Journal article

C2 - 23471197

VL - 24

SP - 665

EP - 676

JO - J AM SOC NEPHROL

JF - J AM SOC NEPHROL

SN - 1046-6673

IS - 4

ER -