Abstract
Anemia is common in chronic kidney disease (CKD). Erythropoietin is the standard treatment for anemia of CKD. We evaluated the frequency and etiologies of erythropoietin-resistant anemia in children under dialysis. A prospective study was conducted at a tertiary academic center from October to March 2020. Erythropoietin-resistant anemia was defined as not achieving target hemoglobin ≥ 11 gr/dl four and 6 months after receiving erythropoietin 300IU/kg/week. Sixty-one patients were enrolled; 49.2% were girls with a median age of 9 years and 4 months. The median time from placement on dialysis was 20.9 months. They consisted of hemodialysis (47.5%) and peritoneal dialysis (52.5%) patients. Erythropoietin (EPO)-resistant anemia was reported in the fourth and sixth months of treatment in 43.1% and 42.85% cases, respectively. The most identified causes in the fourth month of the study were iron deficiency, hyperparathyroidism (each in 36%), drugs (24%), and infections (20%). In the sixth month of the study, iron deficiency (57.15%), hyperparathyroidism (19.04%), and drugs (14.3%) were the most commonly identified etiologies. Age, duration placed on dialysis, gender, and modality of dialysis did not significantly correlate with erythropoietin-resistant anemia (P > 0.05 for all). Mean serum urea and median parathyroid hormone (PTH) levels were significantly higher in cases with EPO-resistant versus EPO-deficient anemia (P = 0.026 and 0.049, respectively). Erythropoietin-resistant anemia was common in children under dialysis. Iron deficiency, hyperparathyroidism, and infections were the main identified etiologies. We found a significant correlation between serum urea and PTH levels with EPO-resistant anemia.
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All data generated or analyzed during this study are available from the corresponding author on a reasonable request.
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Not applicable.
Abbreviations
- dl:
-
Deciliter
- CVD:
-
Cardiovascular diseases
- CKD:
-
Chronic kidney disease
- EPO:
-
Erythropoietin
- HD:
-
Hemodialysis
- PD:
-
Peritoneal dialysis
- Hb:
-
Hemoglobin
- CBC:
-
Complete blood count
- TIBC:
-
Total iron binding capacity
- PTH:
-
Parathyroid hormone
- pg:
-
Pictogram
- gr:
-
Gram
- UTI:
-
Urinary tract infections
- SD:
-
Standard deviation
- ESRD:
-
End-stage renal diseases
- IQR:
-
Inter quartile ranges
- ARB:
-
Angiotensin receptor blocker
- ACEI:
-
Angiotensin-converting enzyme inhibitors
- CRP:
-
C-reactive protein
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Funding
The study was funded by a grant from Mashhad University of Medical Sciences (grant number = 9905210).
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EB, MN: conception or design.
EB, ZL, MN, HF: acquisition, analysis.
EB, ZL, MN, HF, ZHJ: drafting the work.
EB, ZL, MN, HF, ZHJ: final approval.
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Naseri, M., Langari, Z., Bakhtiari, E. et al. The Frequency and Causes of Erythropoietin-Resistant Anemia in Children Under Dialysis. SN Compr. Clin. Med. 6, 39 (2024). https://doi.org/10.1007/s42399-024-01664-8
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DOI: https://doi.org/10.1007/s42399-024-01664-8