title: Analyses of age, gender and other risk factors of erythropoietin resistance in pediatric and adult dialysis cohorts.
abstract: Previous studies often report lower responses to erythropoietin (EPO) therapy in pediatric patients on chronic dialysis than those of adults. Because of the greater capacity for hematopoiesis in the younger population, these studies may be confounded by poorly identified variables. Thus, we made parallel studies of pediatric and adult cohorts to explore the relationship between age, gender and other risk factors with EPO resistance. Thirty pediatric subjects (aged 8-20 years) and 66 adult subjects (aged 22-85 years) on chronic hemodialysis and EPO were enrolled. After stratification by 50th percentile of EPO response, the best predictive model was identified by backward elimination of the risk factors with the least contribution to the regression. Relationship between age, gender and EPO resistance was examined by analysis of covariance (ANCOVA). The most predictive model of EPO response for the pediatric cohort had, as the major variables, urea clearance x dialysis duration/total body water (Kt/V), urea reduction ratio (URR), intact parathyroid hormone (iPTH), blood loss, normalized protein catabolic rates (nPCR) and indices of malnutrition and inflammation, whereas adults had iron and folate deficiencies as the dominant variables. Although EPO resistance was more common in female subjects than in male subjects, relationship with neither age nor gender was significant. Furthermore, the prescription of a larger (initiating) EPO dose by pediatric physicians compared with adult nephrologists confounded the interaction between age and EPO resistance. In summary EPO resistance in the pediatric dialysis cohort was predicted by nutritional deficits, inflammation, poor dialysis, and hyperparathyroidism, while iron and folate deficits were the major determinants in adults. Although confounded by the pattern of EPO prescription, neither age nor gender was predictive of EPO resistance in the two study groups.
authors.affiliation: Department of Pediatrics, Children's Hospital of New Orleans, Louisiana State University Health Science Center, New Orleans, LA 70118, USA. Obamgb@lsuhsc.edu
authors.forename: Oluwatoyin Fatai
authors.initials: OF
authors.lastname: Bamgbola
authors.forename: Fredrick J
authors.initials: FJ
authors.lastname: Kaskel
authors.forename: Maria
authors.initials: M
authors.lastname: Coco
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000188:drug therapy*; D002648:Child; D015331:Cohort Studies; D004351:Drug Resistance; D004921:Erythropoietin / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D006435:Renal Dialysis / Q000009:adverse effects*; D012307:Risk Factors; D012737:Sex Factors
chemical_list: D004921:Erythropoietin
references.citation: Kidney Int. 1991 Jan;39(1):155-63
references.pmid: 2002629
references.citation: Nephron. 2001 Sep;89(1):110-2
references.pmid: 11528242
references.citation: J Pediatr. 2001 May;138(5):710-4
references.pmid: 11343048
references.citation: Blood Rev. 1998 Jun;12(2):106-14
references.pmid: 9661799
references.citation: Am J Physiol. 1991 Sep;261(3 Pt 1):C423-7
references.pmid: 1887870
references.citation: J Gend Specif Med. 2001;4(1):35-40
references.pmid: 11324238
references.citation: ASAIO J. 2005 May-Jun;51(3):236-41
references.pmid: 15968953
references.citation: Nephrology (Carlton). 2006 Oct;11(5):400-4
references.pmid: 17014552
references.citation: Am J Kidney Dis. 1995 Apr;25(4):548-54
references.pmid: 7702049
references.citation: Am J Kidney Dis. 2004 Nov;44(5):866-76
references.pmid: 15492953
references.citation: Adv Perit Dial. 2004;20:111-6
references.pmid: 15384808
references.citation: Perit Dial Int. 2006 Jan-Feb;26(1):64-8
references.pmid: 16538877
references.citation: Blood Purif. 2004;22(5):423-7
references.pmid: 15316197
references.citation: Am J Kidney Dis. 2001 Sep;38(3):518-22
references.pmid: 11532683
references.citation: Am J Kidney Dis. 2005 Oct;46(4):628-34
references.pmid: 16183417
references.citation: Am J Kidney Dis. 2005 Feb;45(2):303-8
references.pmid: 15685508
references.citation: Pediatr Nephrol. 1994 Jun;8(3):338-42
references.pmid: 7917862
references.citation: Am J Kidney Dis. 2001 Dec;38(6):1251-63
references.pmid: 11728958
references.citation: Kidney Int. 2004 Jan;65(1):266-73
references.pmid: 14675059
references.citation: Pediatr Nephrol. 2005 Nov;20(11):1622-9
references.pmid: 16133045
references.citation: Med Princ Pract. 2007;16(1):63-7
references.pmid: 17159367
references.citation: J Am Soc Nephrol. 2006 Apr;17(4 Suppl 2):S74-7
references.pmid: 16565252
references.citation: Am J Kidney Dis. 2006 Feb;47(2):285-93
references.pmid: 16431257
references.citation: Blood Purif. 2006;24(4):387-93
references.pmid: 16755161
references.citation: Kidney Int. 1994 May;45(5):1465-76
references.pmid: 8072260
references.citation: Clin Pharmacokinet. 2004;43(1):57-70
references.pmid: 14715051
references.citation: Kidney Int. 1989 Jan;35(1):134-48
references.pmid: 2651751
references.citation: J Am Soc Nephrol. 2003 Jul;14(7):1776-84
references.pmid: 12819237
references.citation: Kidney Int Suppl. 2006 May;(101):S13-8
references.pmid: 16830701
references.citation: Kidney Int. 2004 Dec;66(6):2429-36
references.pmid: 15569336
references.citation: J Pediatr. 2005 Feb;146(2):245-52
references.pmid: 15689918
references.citation: Int J Artif Organs. 2007 Apr;30(4):325-33
references.pmid: 17520570
references.citation: Blood Purif. 2002;20(4):349-56
references.pmid: 12169844
references.citation: J Endocrinol. 2005 Jul;186(1):61-7
references.pmid: 16002536
references.citation: Am J Kidney Dis. 2005 Sep;46(3):481-8
references.pmid: 16129210
references.citation: Panminerva Med. 2003 Mar;45(1):59-62
references.pmid: 12682621
references.citation: Am J Kidney Dis. 2000 Dec;36(6):1166-74
references.pmid: 11096041
references.citation: Kidney Int. 1999 Aug;56(2):729-37
references.pmid: 10432415
references.citation: Am J Kidney Dis. 1999 Oct;34(4):721-30
references.pmid: 10516355
references.citation: Perit Dial Int. 2003 Mar-Apr;23(2):111-5
references.pmid: 12713075