Abstract
Previous studies in children with chronic kidney disease (CKD) have identified low hemoglobin as a risk factor for poor outcomes. A retrospective review of the North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS) CKD registry was performed to identify the prevalence of and risk factors for anemia among children with stage 3 CKD, including both patients with low hemoglobin and those whose hemoglobin normalized with an erythropoiesis-stimulating agent (ESA). At enrollment, 2,792 patients had stage 3 CKD. Mean age was 9.5 (±0.11) years, 62.1% were male, 61.3% were white, and 43.7% had structural/urologic disease. Among 1,640 of those patients with 12 month follow-up data available for multivariate analysis, 73% met the criteria for anemia. Multivariate logistic regression analysis identifying risk factors for anemia at the 12-month follow-up revealed that, after controlling for estimated glomerular filtration rate, age >2 years, male sex, earlier era of study entry, and prescription of anti-hypertensive medications are associated with an increased risk for anemia at 12 months. In addition, multivariate Cox proportional hazards regression analysis revealed that when patients with ESA-corrected hemoglobin are included in the definition, anemia is not associated with increased risk of progression to end stage renal disease (dialysis initiation or transplantation).
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References
Mitsnefes MM, Kimball TR, Kartal J, Witt SA, Glascock BJ, Khoury PR, Daniels SR (2006) Progression of left ventricular hypertrophy in children with early chronic kidney disease: 2-year follow-up study. J Pediatr 149(5):671–675
Schaefer F (2008) Cardiac disease in children with mild-to-moderate chronic kidney disease. Curr Opin Nephrol Hypertens 17(3):292–297
Gerson A, Hwang W, Fiorenza J, Barth K, Kaskel F, Weiss L, Zelikovsky N, Fivush B, Furth S (2004) Anemia and health-related quality of life in adolescents with chronic kidney disease. Am J Kidney Dis 44(6):1017–1023
Furth SL, Cole SR, Fadrowski JJ, Gerson A, Pierce CB, Chandra M, Weiss R, Kaskel F (2007) The association of anemia and hypoalbuminemia with accelerated decline in GFR among adolescents with chronic kidney disease. Pediatr Nephrol 22(2):265–271
Wuhl E, Schaefer F (2008) Therapeutic strategies to slow chronic kidney disease progression. Pediatr Nephrol 23(5):705–716
Filler G, Mylrea K, Feber J, Wong H (2007) How to define anemia in children with chronic kidney disease? Pediatr Nephrol 22(5):702–707
Staples AO, Wong CS, Smith JM, Gipson DS, Filler G, Warady BA, Martz K, Greenbaum LA (2009) Anemia and risk of hospitalization in pediatric chronic kidney disease. Clin J Am Soc Nephrol 4(1):48–56
Amaral S, Hwang W, Fivush B, Neu A, Frankenfield D, Furth S (2006) Association of mortality and hospitalization with achievement of adult hemoglobin targets in adolescents maintained on hemodialysis. J Am Soc Nephrol 17(10):2878–2885
Schwartz GJ, Brion LP, Spitzer A (1987) The use of plasma creatinine concentration for estimating glomerular filtration rate in infants, children, and adolescents. Pediatr Clin North Am 34(3):571–590
KDOQI (2006) Clinical practice guidelines and clinical practice recommendations for anemia in chronic kidney disease. Am J Kidney Dis 47[5 Suppl 3]:S11–145
K/DOQI (2002) Clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 39(2 Suppl 1):S1–S266
Fadrowski JJ, Pierce CB, Cole SR, Moxey-Mims M, Warady BA, Furth SL (2008) Hemoglobin decline in children with chronic kidney disease: baseline results from the chronic kidney disease in children prospective cohort study. Clin J Am Soc Nephrol 3(2):457–462
United States Growth Charts. Available at: http://www.cdc.gov/nchs/about/major/nhanes/growthcharts/datafiles.htm
Koshy SM, Geary DF (2008) Anemia in children with chronic kidney disease. Pediatr Nephrol 23(2):209–219
Bamgbola OF, Kaskel FJ, Coco M (2009) Analyses of age, gender and other risk factors of erythropoietin resistance in pediatric and adult dialysis cohorts. Pediatr Nephrol 24(3):571–579
Port RE, Mehls O (2009) Erythropoietin dosing in children with chronic kidney disease: based on body size or on hemoglobin deficit? Pediatr Nephrol 24(3):435–437
Rao DS, Shih MS, Mohini R (1993) Effect of serum parathyroid hormone and bone marrow fibrosis on the response to erythropoietin in uremia. N Engl J Med 328(3):171–175
Kruse A, Uehlinger DE, Gotch F, Kotanko P, Levin NW (2008) Red blood cell lifespan, erythropoiesis and hemoglobin control. Contrib Nephrol 161:247–254
Nangaku M, Eckardt KU (2006) Pathogenesis of renal anemia. Semin Nephrol 26(4):261–268
KDOQI (2007) Clinical Practice Guideline and Clinical Practice Recommendations for anemia in chronic kidney disease: 2007 update of hemoglobin target. Am J Kidney Dis 50(3):471–530
McClellan W, Aronoff SL, Bolton WK, Hood S, Lorber DL, Tang KL, Tse TF, Wasserman B, Leiserowitz M (2004) The prevalence of anemia in patients with chronic kidney disease. Curr Med Res Opin 20(9):1501–1510
McFarlane SI, Chen SC, Whaley-Connell AT, Sowers JR, Vassalotti JA, Salifu MO, Lis S, Wang C, Bakris G, McCullough PA, Collins AJ, Norris KC (2008) Prevalence and associations of anemia of CKD: Kidney Early Evaluation Program (KEEP) and National Health and Nutrition Examination Survey (NHANES) 1999-2004. Am J Kidney Dis 51[4 Suppl 2]:S46–S55
Cruzado JM, Rico J, Grinyo JM (2008) The renin angiotensin system blockade in kidney transplantation: pros and cons. Transpl Int 21(4):304–313
Acknowledgment
Dr. Atkinson was supported by grant funding from Amgen, The Thrasher Research Fund, The National Kidney Foundation of Maryland, and The National Kidney Foundation.
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Atkinson, M.A., Martz, K., Warady, B.A. et al. Risk for anemia in pediatric chronic kidney disease patients: a report of NAPRTCS. Pediatr Nephrol 25, 1699–1706 (2010). https://doi.org/10.1007/s00467-010-1538-6
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DOI: https://doi.org/10.1007/s00467-010-1538-6