Tratamiento de la anemia con eritropoietina y hierro en Enfermedad Renal Crónica

Abstract

Erythropoietin and iron in anemia management in chronic renal failureAnemia is one of the most common manifestations of Chronic Renal Failure (CRF), specially during the dialysis period. Growth failure and a high cardiovascular morbimortality are 2 of the most important consequences. Objective: To present a review of the current concepts in diagnosis and management of anemia in pediatric CRF patients. Erythropoietin (EPO) deficit is the main cause of anemia, requiring exogenous replacement through intravenous or subcutaneous route, in hemodialyzed or peritoneodialyzed patients respectively. A longer half-life allows to use EPO one or twice weekly when given by intraperitoneal route, in order to reach a target hemoglobin between 11-12 gr/dl, a level that avoids the cardiovascular risk associated to higher levels as described in adult CRF population. In pediatrics, 100-300 U/kg/weekly can be used to reach the desired hemoglobin levels, always monitoring about the potential complications of EPO, specially arterial hypertension. If anemia seems to be resistent to EPO therapy, iron deficit should be considered and properly treated, as described in this article. Ferritin and saturation of hemoglobin need to be routinely monitored to diagnose iron status in these patients, values less than 100 ng/ml and 20% respectively require exogenous suplementation. Iron doses in pediatrics still need to be defined. Anemia needs to be evaluated and treated in all CRF children, properly management must always be instaured in order to prevent its undesired effects.

Safety and effectiveness of ferric carboxymaltose intravenous therapy in pediatric patients with chronic kidney disease

“…As observed in other studies, patients who received ESAs had lower baseline Hb values, and the observed Hb increase was larger than in those who did not receive ESAs ( 19 ). Patients with kidney disease and iron deficiency are known to require higher doses of ESAs ( 19 ), and the administration of IV iron increases sensitivity to ESAs, making it possible to lower ESA dosages ( 20 , 21 ). In our study, we did not evaluate, the impact on the ESA dose prescribed due its retrospective design and the fact that the study aim was to evaluate tolerance and effectiveness of FCM on the short term.…”

Enfermedad renal crónica en pediatría y nuevos marcadores moleculares

“…La ferritina en plasma representa la reserva de fi erro en los depósitos del organismo (hígado, bazo, médula ósea), recomendándose mantener valores por sobre 100 μg/mL para lograr una adecuada síntesis de hemoglobina 2, 8,38 . En pacientes en hemodiálisis se recomiendan niveles sobre 200 μg/mL.…”

“…Este mecanismo también actúa a nivel intestinal. El resultado de este desbalance es la carencia de fi erro biodisponible para la eritropoyesis 2, 8,40 .…”

“…La introducción de terapias derivadas de la medicina génica permite hoy en día que en la mayoría de los casos el paciente urémico en diálisis no sea diferente de sus pares, y que el período de su vida en que se someten a diálisis peritoneal o hemodiálisis, en espera de un trasplante renal, sea compatible con una vida normal. La introducción de sistemas automatizados de diálisis peritoneal como la Home Choice® (Baxter Healthcare Co), la eritropoyetina humana recombinante (EPO) de vida media corta, mediana y prolongada, la 1,25 (OH) 2 VitD o calcitriol, medicamentos fi jadores de fósforo intestinal, calcimiméticos y fi nalmente la hormona de crecimiento (GH), son la base de un tratamiento médico altamente favorable durante el período en diálisis [4][5][6][7][8] .…”