title: Association of higher erythropoiesis stimulating agent dose and mortality in children on dialysis.
abstract: BACKGROUND
  Higher doses of erythropoiesis-stimulating agents (ESA) have been associated with an increased risk of adverse outcomes in adults with chronic kidney disease (CKD) and end-stage kidney disease (ESRD), but to our knowledge no trials have been performed in children. We examined the association between ESA dose and all-cause mortality in a prevalent pediatric dialysis population.
  
  
  METHODS
  Retrospective cohort study utilizing national data on all prevalent dialysis patients aged <18 years from the Centers for Medicare and Medicaid Services' 2005 ESRD Clinical Performance Measures (CPM) project, linked to 18-month mortality records from the United States Renal Data System. Multivariate Cox proportional hazards regression was performed to determine the risk of mortality by mean weekly ESA dose.
  
  
  RESULTS
  Eight-hundred and twenty-nine children were included in the analysis; 7 % died during follow-up. A higher proportion of patients receiving ESA doses in the highest category (erythropoietin ≥350 units/kg/week or darbepoetin ≥1.5 units/kg/week) died (50 % vs 28 %, p = 0.002), and also demonstrated a trend toward lower hemoglobin (11.0 vs 11.4 g/dL, p = 0.05). In multivariate analysis, patients receiving the highest dose of ESA demonstrated an increased risk of mortality (hazard ratio 3.37; p value <0.01).
  
  
  CONCLUSIONS
  Higher ESA dose is independently associated with mortality in children on chronic dialysis.
authors.affiliation: Division of Nephrology, Children's Hospital of Los Angeles, 4650 Sunset Boulevard, Nephrology Mail Stop #40, Los Angeles, CA, 90027, USA, rlestz@chla.usc.edu.
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Lestz
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Fivush
authors.forename: Meredith A
authors.initials: MA
authors.lastname: Atkinson
mesh_terms: D002648:Child; D015331:Cohort Studies; D000068256:Darbepoetin alfa; D000068817:Epoetin Alfa; D004921:Erythropoietin / Q000009:adverse effects / Q000031:analogs & derivatives; D005260:Female; D006397:Hematinics / Q000009:adverse effects*; D006801:Humans; D008297:Male; D016016:Proportional Hazards Models; D011994:Recombinant Proteins / Q000009:adverse effects; D006435:Renal Dialysis / Q000401:mortality*; D051436:Renal Insufficiency, Chronic / Q000628:therapy; D012189:Retrospective Studies
chemical_list: D006397:Hematinics; D011994:Recombinant Proteins; D004921:Erythropoietin; D000068256:Darbepoetin alfa; D000068817:Epoetin Alfa