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11-03-2013 | Paediatrics | Article

Anemia risk in pediatric CKD varies with country

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medwireNews: The risk for anemia among children undergoing peritoneal dialysis for chronic kidney disease (CKD) may be influenced by country of residence, findings from a global study suggest.

It also appears that the presence of anemia in these patients can increase risk for death while on dialysis, say Franz Schaefer (Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany) and team.

Writing in the Journal of the American Society of Nephrology, they add that using high doses of erythropoiesis-stimulating agents (ESAs) to treat anemia may increase this mortality risk further.

The study, which involved 1394 children aged 1 month to 20 years from 30 different countries enrolled in the International Pediatric Peritoneal Dialysis Network registry, revealed that anemia, defined as a hemoglobin (Hb) level of less than 10.0 or less than 9.5 g/dL in children older or younger than 2 years, respectively, occurred at a rate of 25.5%

A higher mean Hb level of 11.2 g/dL was seen among children living in North America and Europe than in children from Asian countries and Turkey, who had respective mean Hb levels of 10.8 and 10.4 g/dL.

About 84% of patients received iron supplementation, mostly through the oral route. However, "no consistent associations of Hb with the modalities of iron supplementation were apparent. Hence, our findings suggest that factors unrelated to anemia management may underlie the regional variation of anemia prevalence," write the authors.

Just over 4% of patients with a mean Hb level less than 11 g/dL died while on dialysis, compared with 2.6% with a mean Hb level greatr than11 g/dL. Actuarial survival rates were consistently lower in the group with lower Hb levels.

Further analysis of variables among the children revealed a positive correlation between Hb levels and urine output and serum albumin. Conversely, a negative association was observed between Hb levels and patient levels of parathyroid hormone and ferritin.

Ninety-two percent of the study group received ESAs, but no significant association was identified between the efficacy of treatment with ESAs and the type of ESA or dosing interval used. Patient sensitivity to ESA showed positive association with serum albumin, residual diuresis, and low serum parathyroid hormone and ferritin.

Schaefer and co-authors conclude: "The observed association of ESA dose with the mortality of children receiving PD [dialysis] is a novel and potentially important finding that deserves further exploration in other pediatric dialysis populations, as well as in the CKD setting."

By Lauretta Ihonor, medwireNews reporter

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