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.

中文翻译：

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透析儿童促红细胞生成素抵抗性贫血的发生率和原因

摘要

贫血在慢性肾脏病（CKD）中很常见。促红细胞生成素是 CKD 贫血的标准治疗方法。我们评估了透析儿童中促红细胞生成素抵抗性贫血的频率和病因。一项三级学术中心于2020年10月至2020年3月进行了一项前瞻性研究。促红细胞生成素抵抗性贫血被定义为在接受促红细胞生成素300IU/kg/周后4个月和6个月未达到目标血红蛋白≥11 gr/dl。登记了 61 名患者； 49.2%是女孩，中位年龄为9岁零4个月。从进行透析开始的中位时间为 20.9 个月。他们包括血液透析（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% 的病例出现促红细胞生成素 (EPO) 抵抗性贫血。在研究的第四个月中，最确定的原因是缺铁、甲状旁腺功能亢进（各占 36%）、药物（24%）和感染（20%）。在研究的第六个月中，缺铁（57.15%）、甲状旁腺功能亢进（19.04%）和药物（14.3%）是最常见的病因。年龄、透析持续时间、性别和透析方式与促红细胞生成素抵抗性贫血无显着相关性（ 均P > 0.05）。与 EPO 缺乏性贫血相比，EPO 抵抗性贫血患者的平均血清尿素和中位甲状旁腺激素 (PTH) 水平显着较高（P 分别为 0.026 和 0.049）。红细胞生成素抵抗性贫血在透析儿童中很常见。缺铁、甲状旁腺功能亢进和感染是确定的主要病因。我们发现血清尿素和 PTH 水平与 EPO 抵抗性贫血之间存在显着相关性。