Clinical Nephrology – Epidemiology – Clinical Trials

Kidney International (2004) 65, 266–273; doi:10.1111/j.1523-1755.2004.00357.x

Prevalence of anemia in erythropoietin-treated pediatric as compared to adult chronic dialysis patients

BLANCHE M CHAVERS, TRICIA L ROBERTS, CHARLES A HERZOG, ALLAN J COLLINS and WENDY L ST PETER

University of Minnesota, Minneapolis, Minnesota; United States Renal Data System, Minneapolis, Minnesota; and Cardiovascular Special Studies Center, Minneapolis, Minnesota

Correspondence: Blanche M. Chavers, M.D., University of Minnesota Department of Pediatrics, Mayo Mail Code 491, 420 Delaware Street S.E., Minneapolis, MN 55455. E-mail:chave001@tc.umn.edu

Received 31 March 2003; Revised 30 July 2003; Accepted 8 August 2003.

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Abstract

Prevalence of anemia in erythropoietin-treated pediatric as compared to adult chronic dialysis patients.

Background

 

Recent guidelines recommend a target hemoglobin range of 11 to 12 g/dL in pediatric and adult dialysis patients. We compared anemia prevalence in United States Medicare pediatric and adult dialysis patients.

Methods

 

Prevalent hemodialysis patients (0 to 19 years, pediatric: N = 1692; adult: N = 352,291) and peritoneal dialysis patients (pediatric: N = 597; adult: N = 39,136) treated with recombinant human erythropoietin (rHuEPO) from 1996 to 2000 were selected. Mean annual hemoglobin values were calculated by modality, age, sex, and race.

Results

 

Among hemodialysis patients, mean annual hemoglobin values less than 11 g/dL were present in pediatric and adult patients during 54.1% versus 39.8% patient years, respectively (P < 0.0001); for peritoneal dialysis patients, 69.5% versus 55.1% (P < 0.0001). Mean hemoglobin values increased over time and were 11.2, 11.5, 10.8, and 11.2 g/dL for pediatric and adult hemodialysis and peritoneal dialysis patients, respectively, in 2000. Pediatric hemodialysis patients received intravenous iron less frequently than adults (66.3% vs. 82.5% patient years; P < 0.0001).

Conclusion

 

Hemoglobin values in rHuEPO-treated pediatric dialysis patients lagged behind those of adult patients, with pediatric patients achieving target hemoglobin values only a minority of the time (45.9% and 30.5% patient years, respectively, for hemodialysis and peritoneal dialysis). Trends show recent improvement in anemia treatment of children on dialysis. Still, further attention to and analysis of rHuEPO and iron therapy in pediatric dialysis patients is warranted.

Keywords:

anemia, dialysis, erythropoietin, Medicare, pediatrics, peritoneal dialysis

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