Prevalence and predictors of the sub-target Hb level in children on dialysis

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

“…According to the 2008 JSDT guidelines [15], the 2012 KDIGO guidelines [227], and the comments on the 2012 KDIGO guidelines from the KDOQI [228], the criteria for starting iron therapy in pediatric patients with renal anemia are a TSAT of ≤20% and a serum ferritin level of ≤100 ng/mL. However, analysis of data from the Registry of the European Society for Paediatric Nephrology and the European Renal Association-European Dialysis and Transplant Association (ESPN/ERA-EDTA) Registry suggests that the optimal serum ferritin level in pediatric dialysis patients is in the range of 25-50 ng/mL [229]. In addition, a report on the IPPN Registry data showed that pediatric PD patients with serum ferritin levels of 10-25 ng/mL had the highest Hb levels [223].…”

“…Generally, however, the upper limit of serum ferritin level is considered to be 500 ng/mL [230]. Moreover, analyses of the ESPN/ ERA-EDTA Registry data [229] and IPPN Registry data [223] have demonstrated that increasing the serum ferritin level to ≥200 ng/mL does not satisfactorily correct anemia. One study showed that the risk of infectious diseases increased when iron was supplemented in patients with sufficient iron stores [231].…”

Safety and usage of darbepoetin alfa in children with chronic kidney disease: prospective registry study

“…Despite evidence of improved long-term survival rates, mortality in children and adolescents is 55 times greater in those on renal replacement therapy than in children without end-stage renal disease [ 1 , 2 ]. Hypertension and anemia are common complications [ 3 – 7 ]. In a large cohort of North American children aged ≥2 years with CKD and not on dialysis, anemia prevalence increased from 18.5 % in those at stage II to 68 % of those at stage V, and the presence of anemia significantly increased the risk of hospitalization [ 8 ].…”

Hemoglobin level and risk of hospitalization and mortality in children on peritoneal dialysis

“…A low hemoglobin (Hb) level is a common comorbidity in children with end-stage kidney disease (ESKD) and has been associated with various adverse outcomes, including increased mortality, decreased health-related quality of life (HRQOL), and the development and progression of left ventricular hypertrophy [1–6]. Thus, anemia management is a major focus in the care of patients on dialysis.…”