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

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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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Data Availability

All data generated or analyzed during this study are available from the corresponding author on a reasonable request.

Code Availability

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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Authors and Affiliations

  1. Department of Pediatrics Nephrology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

    Mitra Naseri

  2. Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

    Zoha Langari

  3. Clinical Research Development Unit, Mashhad University of Medical Sciences, Mashhad, Iran

    Elham Bakhtiari

  4. Department of Paramedical Sciences, Islamic Azad University, Mashhad, Iran

    Zahra Hashemi Javan

  5. Department of Pediatrics Hematology and Oncology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

    Hamid Farhangi

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  1. Mitra Naseri
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  2. Zoha Langari
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  5. Zahra Hashemi Javan
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Contributions

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.

Corresponding author

Correspondence to Elham Bakhtiari.

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The institutional ethics committee approved the study (IR.MUMS. MEDICAL. REC.1399/244).

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Written consent was obtained from patients or their parents.

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Not applicable.

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The authors declare no competing interests.

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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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