title: Prevalence and predictors of the sub-target Hb level in children on dialysis.
abstract: BACKGROUND
  Anaemia is a common and potentially treatable co-morbidity of end-stage renal disease. We aimed to determine the prevalence of the sub-target haemoglobin (Hb) level among European children on dialysis and to identify factors associated with a low Hb level.
  
  
  METHODS
  From the European Society for Paediatric Nephrology (ESPN)/European Renal Association-European Dialysis Transplant Association (ERA-EDTA) registry, data were available on 2351 children between 1 month and 18 years of age, totalling 5546 measurements from 19 countries.
  
  
  RESULTS
  The mean Hb level was 10.8 g/dL (5th-95th percentiles, 7.4-13.9). Among those above 2 years of age, the mean Hb level was 10.9 g/dL (11.4% below 8.5 g/dL), while it was 10.3 g/dL among those below 2 years (11.2% below 8.0 g/dL). A total of 91.2% of the patients were on an erythropoiesis-stimulating agent (ESA). Hb levels increased with age and were higher in peritoneal dialysis compared with haemodialysis patients. Patients with congenital anomalies of the kidney and urinary tract showed the highest Hb levels, and those with cystic kidney diseases or metabolic disorders the lowest ones. Ferritin levels between 25 and 50 ng/mL were associated with the highest Hb levels. We found a weak inverse association between parathyroid hormone (PTH) and Hb. Whereas standardized blood pressure (BP) was not elevated in patients with above-target Hb, elevated systolic BP z-score was noted in those with sub-target Hb levels.
  
  
  CONCLUSIONS
  Sub-target Hb levels remain common in children on dialysis, in spite of virtually all children being treated with ESA; although we cannot exclude under-dosing. Optimal ferritin levels seemed to be slightly lower in children (25-50 ng/mL) than those in adults. Other risk factors for sub-target Hb are dialysis modality and a high PTH level.
authors: Department of Medical Informatics, University of Amsterdam, Amsterdam, The Netherlands. K.J.vanStralen@amc.uva.nl
authors: Karlijn J
authors: KJ
authors: van Stralen
authors: Leah
authors: L
authors: Krischock
authors: Franz
authors: F
authors: Schaefer
authors: Enrico
authors: E
authors: Verrina
authors: Jaap W
authors: JW
authors: Groothoff
authors: Jonathan
authors: J
authors: Evans
authors: James
authors: J
authors: Heaf
authors: Dimitar
authors: D
authors: Ivanov
authors: Mirjana
authors: M
authors: Kostic
authors: Silvio
authors: S
authors: Maringhini
authors: Ludmila
authors: L
authors: Podracká
authors: Nikoleta
authors: N
authors: Printza
authors: Birute
authors: B
authors: Pundziene
authors: Gyorgy S
authors: GS
authors: Reusz
authors: Karel
authors: K
authors: Vondrak
authors: Kitty J
authors: KJ
authors: Jager
authors: E Jane
authors: EJ
authors: Tizard
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000740:Anemia / Q000097:blood / Q000209:etiology / Q000628:therapy; D001794:Blood Pressure; D001827:Body Height; D002648:Child; D002675:Child, Preschool; D005060:Europe; D005260:Female; D005293:Ferritins / Q000378:metabolism; D006397:Hematinics / Q000627:therapeutic use; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D007223:Infant; D007501:Iron / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D010281:Parathyroid Hormone / Q000097:blood; D012042:Registries; D017582:Renal Replacement Therapy; D012709:Serum Albumin / Q000378:metabolism
chemical_list: D006397:Hematinics; D006454:Hemoglobins; D010281:Parathyroid Hormone; D012709:Serum Albumin; D005293:Ferritins; D007501:Iron