title: Management of anemia in children receiving chronic peritoneal dialysis.
abstract: 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.
authors.affiliation: Pediatric Nephrology Division, Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany.
authors.forename: Dagmara
authors.initials: D
authors.lastname: Borzych-Duzalka
authors.forename: Yelda
authors.initials: Y
authors.lastname: Bilginer
authors.forename: Il Soo
authors.initials: IS
authors.lastname: Ha
authors.forename: Mustafa
authors.initials: M
authors.lastname: Bak
authors.forename: Lesley
authors.initials: L
authors.lastname: Rees
authors.forename: Francisco
authors.initials: F
authors.lastname: Cano
authors.forename: Reyner Loza
authors.initials: RL
authors.lastname: Munarriz
authors.forename: Annabelle
authors.initials: A
authors.lastname: Chua
authors.forename: Silvia
authors.initials: S
authors.lastname: Pesle
authors.forename: Sevinc
authors.initials: S
authors.lastname: Emre
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Urzykowska
authors.forename: Lily
authors.initials: L
authors.lastname: Quiroz
authors.forename: Javier Darío
authors.initials: JD
authors.lastname: Ruscasso
authors.forename: Colin
authors.initials: C
authors.lastname: White
authors.forename: Lars
authors.initials: L
authors.lastname: Pape
authors.forename: Virginia
authors.initials: V
authors.lastname: Ramela
authors.forename: Nikoleta
authors.initials: N
authors.lastname: Printza
authors.forename: Andrea
authors.initials: A
authors.lastname: Vogel
authors.forename: Dafina
authors.initials: D
authors.lastname: Kuzmanovska
authors.forename: Eva
authors.initials: E
authors.lastname: Simkova
authors.forename: Dirk E
authors.initials: DE
authors.lastname: Müller-Wiefel
authors.forename: Anja
authors.initials: A
authors.lastname: Sander
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Warady
authors.forename: Franz
authors.initials: F
authors.lastname: Schaefer
mesh_terms: D000293:Adolescent; D000740:Anemia / Q000097:blood / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006397:Hematinics / Q000008:administration & dosage / Q000627:therapeutic use*; D006454:Hemoglobins; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D015995:Prevalence; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000188:drug therapy / Q000628:therapy; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D006397:Hematinics; D006454:Hemoglobins