title: [Do we successfully treat anemia and calcium-phosphate disorders in children with chronic kidney disease at the beginning of the twenty-first century?].
abstract: In children with chronic kidney disease (CKD) anemia and calcium-phosphate disturbances are already present at early stages of the disease and require a comprehensive treatment. The aim of this study was to evaluate the efficacy of the treatment of biochemical disturbances, depending on the severity of CKD in children.
  
  
  METHODS
  The study included 71 children (44 boys, 27 girls) with CKD stage 1-5. Mean age was 11 ± 5 years, mean height: 135.7 ± 28 cm and mean eGFR 32 ml/min/1.73 m2. The serum hemoglobin, urea, creatinine, cystatin C, calcium, phosphorus and parathyroid hormone (PTH) levels were measured. eGFR was calculated according to Schwartz and Filler formulas, employing creatinine and cystatin C as markers. Patients were divided into groups depending on the stage of CKD [group 1: CKD stage 1+2 (GFR > 60), group 2: CKD stage 3 (GFR = 30-59) Group 3: CKD stage 4 (GFR = 15-29 ml/min/1.73 m2), group 4 - dialyzed children].
  
  
  RESULTS
  The concentration of he- moglobin depending on the stage of CKD (group 1 vs. group 2 vs. group 3 vs group 4) was 12.95 vs. 12.68 vs. 12.47 vs. 11.3 g/dI, respectively. The concentration of total and ionized calcium was significantly lower in children on dialysis compared to patients treated conservatively. With the progression of CKD the concentration of phosphorus (1.39 vs. 1.4 vs. 1.49 vs. 1.82 mmolI) and PTH (21.7 vs 48.6 vs 99.9 vs. 219 pg/ml) significantly increased. Treatment with erythropoietin was used in 48% of children, calcium carbonate in 55% and alphacalcidol in 56% of patients.
  
  
  CONCLUSIONS
  Despite the use of regular treatment, with the progression of CKD a progression of anemia, increased serum phosphate and parathyroid hormone and a decrease in calcium levels in studied children was observed. The severity of metabolic disorders in dialyzed children indicates the need for administration of new and more effective drugs, to prevent early enough complications of CKD in the form of mineral bone disease and cardiovascular complications.
authors.forename: Dorota
authors.initials: D
authors.lastname: Drożdż
authors.forename: Przemko
authors.initials: P
authors.lastname: Kwinta
authors.forename: Krystyna
authors.initials: K
authors.lastname: Sztefko
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Zachwieja
authors.forename: Monika
authors.initials: M
authors.lastname: Miklaszewska
authors.forename: Tomasz
authors.initials: T
authors.lastname: Drożdż
authors.forename: Monika
authors.initials: M
authors.lastname: Łatka
authors.forename: Jacek A
authors.initials: JA
authors.lastname: Pietrzyk
mesh_terms: D000293:Adolescent; D000740:Anemia / Q000188:drug therapy* / Q000209:etiology; D002119:Calcium Carbonate / Q000627:therapeutic use; D002648:Child; D018450:Disease Progression; D004921:Erythropoietin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006887:Hydroxycholecalciferols / Q000627:therapeutic use; D054559:Hyperphosphatemia / Q000188:drug therapy* / Q000209:etiology; D006996:Hypocalcemia / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D010281:Parathyroid Hormone / Q000097:blood; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D016896:Treatment Outcome
chemical_list: D006887:Hydroxycholecalciferols; D010281:Parathyroid Hormone; D004921:Erythropoietin; D002119:Calcium Carbonate; C008088:alfacalcidol