Recombinant human erythropoietin dosage in children undergoing hemodialysis and continuous ambulatory peritoneal dialysis

Abstract

The efficacy of erythropoietin (EPO) in 11 children on hemodialysis (HD) and 8 on continuous ambulatory peritoneal dialysis (CAPD) (mean age 11.8 years) was compared. The initial EPO dose was 50 U/kg s.c. once a week; the time of observation was 24 weeks. In the CAPD group, the mean hemoglobin (Hb) level increased from 7.7 +/- 0.2 to 11.2 +/- 0.6 g/dl (P < 0.001) and hematocrit (Hct) from 22.3 +/- 1.0 to 32.6 +/- 1.4% (P < 0.001), while in the HD group the mean Hb rose from 7.7 +/- 0.6 to 9.3 +/- 0.8 g/dl (P < 0.001) and mean Hct from 22.7 +/- 2.3 to 27.6 +/- 2.8% (P < 0.001) after 12 weeks of observation. An increase in Hb to over 10 g/dl was obtained in 87.5% of children on CAPD but in only 10% on HD after 8 weeks of EPO treatment. After 12 weeks of treatment, all children on CAPD had the target Hb level of more than 10 g/dl, while 7 children on HD required increased doses of EPO (100 U/kg per week). We conclude that the EPO dose of 50 u/kg given s.c. once a week is effective for children with anemia on CAPD but is insufficient for children on HD.

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

“…However, in the small subset of incident patients with a valid body weight measurement at initiation of dialysis, we showed that pediatric hemodialysis and peritoneal dialysis patients received mean weekly rHuEPO doses of 208 and 121 U/kg, respectively, and that these doses were significantly higher than those received by adults. Although the NAPRTCS report did not include rHuEPO/kg, these results are consistent with the results of smaller pediatric studies showing higher rHuEPO dose requirements in pediatric patients of small body weight [14,16,[18][19][20][21]. In the subset of incident patients with an indication on the Medical Evidence Report of rHuEPO use before dialysis, the percentages of patients treated with rHuEPO were similar for pediatric and adult hemodialysis patients, and were slightly, but not significantly, lower in pediatric than in adult peritoneal dialysis patients.…”

“…Studies of pediatric dialysis patients have suggested that patient age, size, and dialysis type are factors in the response to rHuEPO [14,[18][19][20][21]. A study of 116 pediatric hemodialysis patients found that children weighing less than 30 kg required twice the dose of rHuEPO (225 U/kg per week vs. 107 U/ kg per week) as those weighing more than 30 kg to reach a hemoglobin value of 9.6 g/dL [ 14].…”

Hemoglobin Levels and Erythropoietin Doses in Hemodialysis and Peritoneal Dialysis Patients in the United States

“…At steady state, erythropoietin doses were 32% lower with use of the subcutaneous route (22). Observational data suggest that anemia is less common and more sensitive to erythropoietin in peritoneal dialysis patients than in hemodialysis patients, possibly because blood loss is less marked and residual renal function may be better preserved in patients who receive peritoneal dialysis (12)(13)(14)(15)(16)(17)(18)(19)(20). Also, in hemodialysis patients, blood is usually drawn before a dialysis session; as a result, hemoglobin is likely to be partly diluted.…”

“…It has long been believed that peritoneal dialysis patients tend to be less anemic than hemodialysis patients (12)(13)(14)(15)(16)(17)(18)(19). Possible biologic mechanisms for this include superior preservation of residual renal function in peritoneal dialysis patients, blood loss during dialysis sessions in hemodialysis patients, and differences between modalities in the cyclicity and pattern of uremic toxin removal (20).…”

Anemia in Children with Chronic Kidney Disease

“…Administration of rHuEPO has been shown to be effective in children with CKD. 29 Factors affecting the necessary dose per kilogram of rHuEPO include the stage of CKD (higher in stage 5), the mode of dialysis (higher in HD because of increased blood loss), 36 the age of the patient (higher in younger patients), 17,37 the route of administration (higher with IV v subcutaneous), 17 and the dosing frequency (higher with less frequent dosing regimens). Nevertheless, individual variation has a significant impact on the rHuEPO dose requirements.…”