Erythropoietin dosing in children with chronic kidney disease: based on body size or on hemoglobin deficit?

There are no investigations demonstrating that body size-adapted doses of erythropoietin (EPO) are as equally effective in children as in adults. A treatment starting with 150 IU/kg body weight per week leads to an insufficient rise in hemoglobin levels in anemic children with chronic kidney disease (CKD). Nevertheless, this strategy is widely used and seems to be the reason for a high percentage of young anemic children in spite of EPO treatment. In children and in adults, 1,000 IU EPO intravenously increases the hemoglobin level equally by 0.04 g/l. This strongly argues for specifying the EPO dose in the treatment of children with CKD in absolute amounts. A prediction model exists which allows the determination of the EPO dose which is expected to raise hemoglobin from a given pretreatment level to a desired steady state level.