Prevalence of anemia in erythropoietin-treated pediatric as compared to adult chronic dialysis patients

Chavers, Blanche M.; Roberts, Tricia; Herzog, Charles A.; Collins, Allan J.; Peter, Wendy L. St.

doi:10.1111/j.1523-1755.2004.00357.x

Cited by 42 publications

(24 citation statements)

References 32 publications

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“…In this study, nearly half of children were below target, with nearly a 10th of the population having very low Hb levels, despite virtually all patients being prescribed ESAs. This finding is consistent with data from the USA, showing the prevalence of Hb levels below 11 g/dL between 33 and 54% of HD patients [2,[24][25][26] and between 31 and 70% of PD patients [2,24], and the presence of anaemia (including the use of ESA in defining anaemia) in 97% of paediatric Stage 5 CKD patients [27]. As in a US study [24], ESAs were prescribed in over 90% of dialysis children.…”

Section: Discussionsupporting

confidence: 89%

“…Anaemia is a common feature among children with endstage renal disease (ESRD) [1], due mainly to impaired erythropoietin synthesis by the diseased kidneys, and an absolute or functional iron deficiency [2]. Other contributing factors include inflammation, regular blood loss, vitamin deficiency, hyperparathyroidism, haemoglobinopathies, haemolysis, uraemia and medications [1].…”

Section: Introductionmentioning

confidence: 99%

“…Nevertheless, anaemia remains a significant problem, with anaemia present in half of the children on chronic haemodialysis (HD) and PD in a US study [2]. The prevalence of the sub-target Hb level in children on dialysis across Europe is not well defined.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Stralen

Krischock

Schaefer

et al. 2012

Nephrology Dialysis Transplantation

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

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

Stralen

Krischock

Schaefer

et al. 2012

Nephrology Dialysis Transplantation

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“…Correction of anaemia through erythropoiesis stimulation leads to decreased blood transfusion requirements and anti-HLA immunisation [2], increased appetite and tolerance to exercise [3,4] and improved school performance or quality of life [5,6]. Recombinant human erythropoietin (r-HuEPO) has become the standard of care in treating anaemia associated with chronic renal failure (CRF) in adults [7][8][9] as well as in children [10,11]. Conventional r-HuEPO requires two to three subcutaneous or intravenous injections per week over long periods of time, until successful kidney transplantation restores kidney function.…”

Section: Introductionmentioning

confidence: 99%

Darbepoetin, effective treatment of anaemia in paediatric patients with chronic renal failure

et al. 2007

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Darbepoetin alfa (DA) is a unique long-acting treatment for anaemia in patients with chronic renal failure (CRF). This study assessed the mean dose of DA to achieve and maintain haemoglobin (Hb) levels between 11 g/dl and 13 g/dl in CRF children aged 11 years to 18 years. This observational, prospective study was conducted in 39 patients treated with DA. Twenty-nine patients were switched from recombinant human erythropoietin (r-HuEPO), and ten patients were naive to r-HuEPO. Naive patients received initial doses of 0.45 μg/kg of DA. Switched patients received a dose adjusted to the prior dose of r-HuEPO (200 IU r-HuEPO:1 μg DA). Among the switched patients, 79.3% received dialysis. No naive patients underwent dialysis. Overall, 74% of patients showed increased Hb level, with a mean value of 11.6±1.6 g/dl, using a mean DA dose of 0.63±0.48 μg/kg per week, and 66.7% patients reached the Pediatr Nephrol (2007) target Hb level. Hb increased in naive patients from 9.5 (95% CI: 7.7, 11.4) to 11.7 (95% CI: 10.9, 12.6) g/dl and in switched patients from 11.1 (95% CI: 10.6, 11.5) to 11.5 (95% CI: 10.8, 12.2) g/dl). Higher doses of DA were needed in the "switched" than in the "naive" patients to maintain Hb levels over 11 g/dl, respectively 0.73 (95% CI: 0.54, 0.92) and 0.34 (95% CI: 0.16, 0.52) μg/kg per week. Our results indicate the doses of DA necessary to treat CRF patients aged 11 years to 18 years. DA was an effective treatment to stabilise CRF patients at extended dosing intervals.

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“…Whereas studies have shown anemia to be considerably more prevalent among pediatric dialysis patients than among adult patients, the bulk of the research on anemia in hemodialysis (HD) patients has been conducted in adults. It is widely recognized, however, that pediatric patients who receive HD experience chronic blood loss and resultant iron deficiency (2). In fact, iron loss is expected to be even greater in smaller children than in adults because equal volumes of obligate blood loss with each dialysis session represents a larger fraction of the total iron pool.…”

mentioning

confidence: 99%

Single-Dosage Pharmacokinetics of Sodium Ferric Gluconate Complex in Iron-Deficient Pediatric Hemodialysis Patients

Warady¹,

Seligman²,

Dahl³

2007

Clinical Journal of the American Society of Nephrology

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Background and objectives:The clinical use of sodium ferric gluconate complex in iron-deficient pediatric patients receiving hemodialysis was recently approved. This study was designed to describe the pharmacokinetic parameters of the medication.Design, setting, participants, & measurements: Iron-deficient pediatric (<15 yr) hemodialysis patients were randomly assigned to two doses (1.5 and 3.0 mg/kg) of sodium ferric gluconate complex. Blood samples taken during a 1-h infusion and at multiple intervals during 48 h were analyzed for total iron, transferrin-bound iron, and sodium ferric gluconate complexbound iron.Results: Forty-nine patients (mean age 12.3 ؎ 2.5 yr) participated in the study. Mean serum iron concentrations rapidly increased in a dosage-dependent manner. A rapid rise in total serum iron was followed by a slower, less prominent rise in transferrin-bound iron. This was qualitatively confirmed by visualization of the transferrin bands from polyacrylamide gel electrophoresis. Single-dose pharmacokinetics of sodium ferric gluconate complex-bound iron was described using noncompartmental analytical methods. Mean values for the 1.5 mg/Kg dose were as follows: t 1/2 2.0 ؎ 0.7 h, C max 1287 mcg/dl, T max 1.1 ؎ 0.23 h, Cl 0.69 ؎ 0.50 L/h, Vd 1.6 ؎ 0.6 L, AUC 0-ؕ . 9499 ؎ 4089 mcg ⅐ hr/dl.Conclusions: The infusion of sodium ferric gluconate complex to pediatric patients who receive hemodialysis appears to result in a delayed transfer of iron to transferrin, likely after an initial movement through the reticuloendothelial system. Differences noted between the pediatric and adult pharmacokinetic data may result from the unique aspects of the study populations and the respective study designs.

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Prevalence of anemia in erythropoietin-treated pediatric as compared to adult chronic dialysis patients

Cited by 42 publications

References 32 publications

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

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

Darbepoetin, effective treatment of anaemia in paediatric patients with chronic renal failure

Single-Dosage Pharmacokinetics of Sodium Ferric Gluconate Complex in Iron-Deficient Pediatric Hemodialysis Patients

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