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Pediatric Nephrology
Published in: Pediatric Nephrology 10/2014

01-10-2014 | Original Article

Association of higher erythropoiesis stimulating agent dose and mortality in children on dialysis

Authors: Rachel M. Lestz, Barbara A. Fivush, Meredith A. Atkinson

Published in: Pediatric Nephrology | Issue 10/2014

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Abstract

Background

Higher doses of erythropoiesis-stimulating agents (ESA) have been associated with an increased risk of adverse outcomes in adults with chronic kidney disease (CKD) and end-stage kidney disease (ESRD), but to our knowledge no trials have been performed in children. We examined the association between ESA dose and all-cause mortality in a prevalent pediatric dialysis population.

Methods

Retrospective cohort study utilizing national data on all prevalent dialysis patients aged <18 years from the Centers for Medicare and Medicaid Services’ 2005 ESRD Clinical Performance Measures (CPM) project, linked to 18-month mortality records from the United States Renal Data System. Multivariate Cox proportional hazards regression was performed to determine the risk of mortality by mean weekly ESA dose.

Results

Eight-hundred and twenty-nine children were included in the analysis; 7 % died during follow-up. A higher proportion of patients receiving ESA doses in the highest category (erythropoietin ≥350 units/kg/week or darbepoetin ≥1.5 units/kg/week) died (50 % vs 28 %, p = 0.002), and also demonstrated a trend toward lower hemoglobin (11.0 vs 11.4 g/dL, p = 0.05). In multivariate analysis, patients receiving the highest dose of ESA demonstrated an increased risk of mortality (hazard ratio 3.37; p value <0.01).

Conclusion

Higher ESA dose is independently associated with mortality in children on chronic dialysis.
Literature
1.
Amaral S, Hwang W, Fivush B, Neu A, Frankenfield D, Furth S (2006) Association of mortality and hospitalization with achievement of adult hemoglobin targets in adolescents maintained on hemodialysis. J Am Soc Nephrol 17:2878–2885PubMedCrossRef
2.
Borzych-Duzalka D, Bilginer Y, Ha IS, Bak M, Rees L, Cano F, Munarriz RL, Chua A, Pesle S, Emre S, Urzykowska A, Quiroz L, Ruscasso JD, White C, Pape L, Ramela V, Printza N, Vogel A, Kuzmanovska D, Simkova E, Muller-Weifel DE, Sander A, Warady BA, Schaefer F (2013) Management of anemia in children receiving chronic peritoneal dialysis. J Am Soc Nephrol 24:665–676PubMedCrossRefPubMedCentral
3.
Collins AJ, Ma JZ, Ebben J (2000) Impact of hematocrit on morbidity and mortality. Semin Nephrol 20:345–349PubMed
4.
Drueke TB, Locatelli F, Clyne N, Eckardt KU, Macdougall IC, Tsakiris D, Burger HU, Scherhag A, CREATE Investigators (2006) Normalization of hemoglobin level in patients with chronic kidney disease and anemia. N Engl J Med 355:2071–2084PubMedCrossRef
5.
Foley RN, Parfrey PS, Morgan J, Barre PE, Campbell P, Cartier P, Coyle D, Fine A, Handa P, Kingma I, Lau CY, Levin A, Mendelssohn D, Muirhead N, Murphy B, Plante RK, Posen G, Wells GA (2000) Effect of hemoglobin levels in hemodialysis patients with asymptomatic cardiomyopathy. Kidney Int 58:1325–1335PubMedCrossRef
6.
Furuland H, Linde T, Ahlmen J, Christensson A, Strombom U, Danielson BG (2003) A randomized controlled trial of haemoglobin normalization with epoetin alfa in pre-dialysis and dialysis patients. Nephrol Dial Transplant 18:353–361PubMedCrossRef
7.
Singh AK, Szczech L, Tang KL, Barnhart H, Sapp S, Wolfson M, Reddan D, CHOIR Investigators (2006) Correction of anemia with epoetin alfa in chronic kidney disease. N Engl J Med 355:2085–2098PubMedCrossRef
8.
Besarab A, Bolton WK, Browne JK, Egrie JC, Nissenson AR, Okamoto DM, Schwab SJ, Goodkin DA (1998) The effects of normal as compared with low hematocrit values in patients with cardiac disease who are receiving hemodialysis and epoetin. N Engl J Med 339:584–590PubMedCrossRef
9.
KDOQI (2007) KDOQI clinical practice guideline and clinical practice recommendations for anemia in chronic kidney disease: 2007 update of hemoglobin target. Am J Kidney Dis 50:471–530CrossRef
10.
Pfeffer MA, Burdmann EA, Chen CY, Cooper ME, de Zeeuw D, Eckardt KU, Feyzi JM, Ivanovich P, Kewalramani R, Levey AS, Lewis EF, McGill JB, McMurray JJ, Parfrey P, Parving HH, Remuzzi G, Singh AK, Solomon SD, Toto R, TREAT Investigators (2009) A trial of darbepoetin alfa in type 2 diabetes and chronic kidney disease. N Engl J Med 361:2019–2032PubMedCrossRef
11.
Kliger AS, Foley RN, Goldfarb DS, Goldstein SL, Johansen K, Singh A, Szczech L (2013) KDOQI US commentary on the 2012 KDIGO clinical practice guideline for anemia in CKD. Am J Kidney Dis 62:849–859PubMedCrossRef
12.
Kidney Disease: Improving Global Outcomes (KDIGO) Anemia Work Group (2012) KDIGO clinical practice guideline for anemia in chronic kidney disease. Kidney Int Suppl 2:279–335CrossRef
13.
Neu AM, Frankenfield DL (2009) Clinical outcomes in pediatric hemodialysis patients in the USA: lessons from CMS’ ESRD CPM project. Pediatr Nephrol 24:1287–1295PubMedCrossRefPubMedCentral
14.
15.
Amaral S, Hwang W, Fivush B, Neu A, Frankenfield D, Furth S (2008) Serum albumin level and risk for mortality and hospitalization in adolescents on hemodialysis. Clin J Am Soc Nephrol 3:759–767PubMedCrossRefPubMedCentral
16.
Morgenstern B, Nair KS, Lerner G, Neu A, Quan A, Warady BA, Pediatric Peritoneal Dialysis Study Consortium (2001) Impact of total body water errors on kt/V estimates in children on peritoneal dialysis. Adv Perit Dial 17:260–263PubMed
17.
Hemodialysis Adequacy 2006 Work Group (2006) KDOQI clinical practice guidelines for hemodialysis adequacy, update 2006. Am J Kidney Dis 48:S2–S90CrossRef
18.
KDOQI (2006) KDOQI clinical practice guidelines for peritoneal dialysis adequacy, update 2006. Am J Kidney Dis 48:S91–S158CrossRef
19.
Zhang Y, Thamer M, Stefanik K, Kaufman J, Cotter DJ (2004) Epoetin requirements predict mortality in hemodialysis patients. Am J Kidney Dis 44:866–876PubMedCrossRef
20.
Port RE, Mehls O (2009) Erythropoietin dosing in children with chronic kidney disease: based on body size or on hemoglobin deficit? Pediatr Nephrol 24:435–437PubMedCrossRef
21.
Atkinson MA, Furth SL (2011) Anemia in children with chronic kidney disease. Nat Rev Nephrol 7:635–641PubMedCrossRef
22.
23.
Badve SV, Hawley CM, Johnson DW (2011) Is the problem with the vehicle or the destination? does high-dose ESA or high haemoglobin contribute to poor outcomes in CKD? Nephrol (Carlton) 16:144–153CrossRef
24.
Staples AO, Wong CS, Smith JM, Gipson DS, Filler G, Warady BA, Martz K, Greenbaum LA (2009) Anemia and risk of hospitalization in pediatric chronic kidney disease. Clin J Am Soc Nephrol 4:48–56PubMedCrossRefPubMedCentral
25.
Goodkin DA, Fuller DS, Robinson BM, Combe C, Fluck R, Mendelssohn D, Akizawa T, Pisoni RL, Port FK (2011) Naturally occurring higher hemoglobin concentration does not increase mortality among hemodialysis patients. J Am Soc Nephrol 22:358–365PubMedCrossRefPubMedCentral
26.
Koulouridis I, Alfayez M, Trikalinos TA, Balk EM, Jaber BL (2013) Dose of erythropoiesis-stimulating agents and adverse outcomes in CKD: a metaregression analysis. Am J Kidney Dis 61:44–56PubMedCrossRefPubMedCentral
27.
Goodnough LT, Nemeth E, Ganz T (2010) Detection, evaluation, and management of iron-restricted erythropoiesis. Blood 116:4754–4761PubMedCrossRef
28.
Atkinson MA, White CT (2012) Hepcidin in anemia of chronic kidney disease: review for the pediatric nephrologist. Pediatr Nephrol 27:33–40PubMedCrossRef
29.
Zaritsky J, Young B, Wang HJ, Westerman M, Olbina G, Nemeth E, Ganz T, Rivera S, Nissenson AR, Salusky IB (2009) Hepcidin—a potential novel biomarker for iron status in chronic kidney disease. Clin J Am Soc Nephrol 4:1051–1056PubMedCrossRefPubMedCentral
30.
Bamgbola OF, Kaskel FJ, Coco M (2009) Analyses of age, gender and other risk factors of erythropoietin resistance in pediatric and adult dialysis cohorts. Pediatr Nephrol 24:571–579PubMedCrossRef
Metadata
Title
Association of higher erythropoiesis stimulating agent dose and mortality in children on dialysis
Authors
Rachel M. Lestz
Barbara A. Fivush
Meredith A. Atkinson
Publication date
01-10-2014
Publisher
Springer Berlin Heidelberg
Published in
Pediatric Nephrology / Issue 10/2014
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI
https://doi.org/10.1007/s00467-014-2820-9

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