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Association of higher erythropoiesis stimulating agent dose and mortality in children on dialysis

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Abstract

Background

Higher doses of erythropoiesis-stimulating agents (ESA) have been associated with an increased risk of adverse outcomes in adults with chronic kidney disease (CKD) and end-stage kidney disease (ESRD), but to our knowledge no trials have been performed in children. We examined the association between ESA dose and all-cause mortality in a prevalent pediatric dialysis population.

Methods

Retrospective cohort study utilizing national data on all prevalent dialysis patients aged <18 years from the Centers for Medicare and Medicaid Services’ 2005 ESRD Clinical Performance Measures (CPM) project, linked to 18-month mortality records from the United States Renal Data System. Multivariate Cox proportional hazards regression was performed to determine the risk of mortality by mean weekly ESA dose.

Results

Eight-hundred and twenty-nine children were included in the analysis; 7 % died during follow-up. A higher proportion of patients receiving ESA doses in the highest category (erythropoietin ≥350 units/kg/week or darbepoetin ≥1.5 units/kg/week) died (50 % vs 28 %, p = 0.002), and also demonstrated a trend toward lower hemoglobin (11.0 vs 11.4 g/dL, p = 0.05). In multivariate analysis, patients receiving the highest dose of ESA demonstrated an increased risk of mortality (hazard ratio 3.37; p value <0.01).

Conclusion

Higher ESA dose is independently associated with mortality in children on chronic dialysis.

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Acknowledgements

Dr Atkinson was supported by a grant from the NIH/National Institute of Diabetes and Digestive Diseases K23-DK-084116. Dr Lestz received support from the National Institutes of Health Research Training Program Grant # 732 DK007732.

Disclaimer

The findings and conclusions in this article are those of the authors and do not necessarily represent the official policy or interpretation of the Centers for Medicare and Medicaid Services, the United States Renal Data System (USRDS), or the US government.

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Authors and Affiliations

  1. Division of Nephrology, Children’s Hospital of Los Angeles, 4650 Sunset Boulevard, Nephrology Mail Stop #40, Los Angeles, CA, 90027, USA

    Rachel M. Lestz

  2. Division of Pediatric Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Barbara A. Fivush & Meredith A. Atkinson

Authors
  1. Rachel M. Lestz
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  2. Barbara A. Fivush
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  3. Meredith A. Atkinson
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Correspondence to Rachel M. Lestz.

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Lestz, R.M., Fivush, B.A. & Atkinson, M.A. Association of higher erythropoiesis stimulating agent dose and mortality in children on dialysis. Pediatr Nephrol 29, 2021–2028 (2014). https://doi.org/10.1007/s00467-014-2820-9

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  • DOI: https://doi.org/10.1007/s00467-014-2820-9

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