Management of anemia with erythropoietic-stimulating agents in children with chronic kidney disease

Abstract

Anemia management is an important component of the care provided to children with chronic kidney disease (CKD) and influences both morbidity and mortality risk. The introduction of recombinant human erythropoietin to the treatment regimen three decades ago revolutionized the therapy and significantly decreased the need for repeated blood transfusions and exposure to associated risks. Recent data on the efficacy and complications associated with erythropoietic-stimulating agent (ESA) usage has, however, prompted a reassessment of treatment-related recommendations. This review will address these recommendations, in addition to describing pediatric outcomes associated with current ESAs and presenting information on alternative ESAs, many of which will likely soon be incorporated into clinical practice.

2015 Japanese Society for Dialysis Therapy: Guidelines for Renal Anemia in Chronic Kidney Disease

“…Vitamin B 12 , folic acid, vitamin C, and carnitine greatly affect the formation of normal mature RBCs, and deficiencies of these nutrients cause anemia in addition to iron deficiency. Therefore, proper nutritional management, including the supplementation of these nutrients, is essential [219].…”

“…However, applying this value to children, who are less likely to have arteriosclerosis or cardiovascular complications as basic diseases, may be problematic. The target Hb levels for children in the development period should be set considering indices such as growth, mental and physical development, attendance at preschool or primary school, and learning and physical abilities, which are different from the indices for adults [219,224,225]. In clinical practice, a comparison among three patient groups (Hb levels of <11, ≥11 and <12, and ≥12 g/dL) showed that QOL, including health state and physical functions, was a better index for patients with Hb levels of ≥12 g/dL [222].…”

“…Thus, providing appropriate dialysis is essential for children to maintain ESA responsiveness. Attention should also be paid to medication nonadherence in children [219]. For details on ESA hyporesponsiveness, refer to Chapter 5 ("ESA hyporesponsiveness").…”

Chronic kidney disease in children

“…Anaemia of CKD is the result of many interacting factors, but decreased production of erythropoietin by the unhealthy kidney and iron dysregulation (including iron deficiency and iron-restricted erythropoiesis) are the primary defects [ 75 – 78 ]. Treatment with recombinant human erythropoietin (rHuEPO) is safe and effective, both in children with conservatively treated CKD and in those on maintenance dialysis [ 79 , 80 ]. As in adults, the goal of this treatment is to achieve target haemoglobin levels of approximately 11 g/dL or slightly greater.…”

Peran Hepcidin Dan Vitamin D Dalam Patofisiologi Anemia Pada Anak Dengan Penyakit Ginjal Kronik

“…Anaemia is a risk factor for the incidence of cardiovascular disease, which is the leading cause of death in patients with CKD and increases the progression of CKD. [1][2][3] Chronic disease anaemia (CDA), iron deficiency anaemia (IDA), functional iron deficiency, respectively or simultaneously cause inhibition of erythropoiesis (IRE) and cause anaemia in CKD. This condition adds to the complexity of the diagnosis and management of anaemia in CKD.…”