The Frequency and Causes of Erythropoietin-Resistant Anemia in Children Under Dialysis

SN Comprehensive Clinical Medicine Pub Date : 2024-04-03 DOI:10.1007/s42399-024-01664-8

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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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接受透析的儿童出现促红细胞生成素抵抗性贫血的频率和原因

摘要慢性肾脏病（CKD）常见贫血。促红细胞生成素是治疗 CKD 贫血的标准疗法。我们评估了透析儿童出现红细胞生成素抵抗性贫血的频率和病因。一项前瞻性研究于 2020 年 10 月至 3 月在一家三级学术中心进行。红细胞生成素耐药性贫血的定义是：接受红细胞生成素 300IU/kg/week 治疗 4 个月和 6 个月后，血红蛋白≥ 11 gr/dl。共有 61 名患者入选，其中 49.2% 为女孩，中位年龄为 9 岁零 4 个月。接受透析治疗的中位时间为 20.9 个月。其中包括血液透析（47.5%）和腹膜透析（52.5%）患者。在治疗的第四个月和第六个月，分别有43.1%和42.85%的患者出现了红细胞生成素（EPO）抵抗性贫血。研究第四个月发现最多的原因是缺铁、甲状旁腺功能亢进（各占 36%）、药物（24%）和感染（20%）。在研究的第六个月，最常见的病因是缺铁（57.15%）、甲状旁腺功能亢进（19.04%）和药物（14.3%）。年龄、透析时间、性别和透析方式与促红细胞生成素抵抗性贫血无明显相关性（P > 0.05）。EPO抵抗性贫血患者的平均血清尿素和甲状旁腺激素（PTH）中位数水平明显高于EPO缺乏性贫血患者（P=0.026和0.049）。在接受透析治疗的儿童中，抗促红细胞生成素性贫血很常见。缺铁、甲状旁腺功能亢进和感染是主要的病因。我们发现血清尿素和 PTH 水平与 EPO 抗性贫血之间存在明显的相关性。

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SN Comprehensive Clinical Medicine

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