Prevalence and predictors of the sub-target Hb level in children on dialysis

Karlijn J. Van Stralen, Leah Krischock, Franz Schaefer, Enrico Verrina, Jaap W. Groothoff, Jonathan Evans, James Heaf, Dimitar Ivanov, Mirjana Kostic, Silvio Maringhini, Ludmila Podracká, Nikoleta Printza, Birute Pundziene, Gyorgy S. Reusz, Karel Vondrak, Kitty J. Jager, E. Jane Tizard

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Abstract

BackgroundAnaemia is a common and potentially treatable co-morbidity of end-stage renal disease. We aimed to determine the prevalence of the sub-target haemoglobin (Hb) level among European children on dialysis and to identify factors associated with a low Hb level.MethodsFrom the European Society for Paediatric Nephrology (ESPN)/European Renal Association-European Dialysis Transplant Association (ERA-EDTA) registry, data were available on 2351 children between 1 month and 18 years of age, totalling 5546 measurements from 19 countries.ResultsThe mean Hb level was 10.8 g/dL (5th-95th percentiles, 7.4-13.9). Among those above 2 years of age, the mean Hb level was 10.9 g/dL (11.4 below 8.5 g/dL), while it was 10.3 g/dL among those below 2 years (11.2 below 8.0 g/dL). A total of 91.2 of the patients were on an erythropoiesis- stimulating agent (ESA). Hb levels increased with age and were higher in peritoneal dialysis compared with haemodialysis patients. Patients with congenital anomalies of the kidney and urinary tract showed the highest Hb levels, and those with cystic kidney diseases or metabolic disorders the lowest ones. Ferritin levels between 25 and 50 ng/mL were associated with the highest Hb levels. We found a weak inverse association between parathyroid hormone (PTH) and Hb. Whereas standardized blood pressure (BP) was not elevated in patients with above-target Hb, elevated systolic BP z-score was noted in those with sub-target Hb levels.ConclusionsSub-target Hb levels remain common in children on dialysis, in spite of virtually all children being treated with ESA; although we cannot exclude under-dosing. Optimal ferritin levels seemed to be slightly lower in children (25-50 ng/mL) than those in adults. Other risk factors for sub-target Hb are dialysis modality and a high PTH level.

Original languageEnglish
Pages (from-to)3950-3957
Number of pages8
JournalNephrology Dialysis Transplantation
Volume27
Issue number10
DOIs
Publication statusPublished - Oct 1 2012

Keywords

  • Hb
  • anaemia
  • children
  • dialysis

ASJC Scopus subject areas

  • Nephrology
  • Transplantation

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    Van Stralen, K. J., Krischock, L., Schaefer, F., Verrina, E., Groothoff, J. W., Evans, J., Heaf, J., Ivanov, D., Kostic, M., Maringhini, S., Podracká, L., Printza, N., Pundziene, B., Reusz, G. S., Vondrak, K., Jager, K. J., & Jane Tizard, E. (2012). Prevalence and predictors of the sub-target Hb level in children on dialysis. Nephrology Dialysis Transplantation, 27(10), 3950-3957. https://doi.org/10.1093/ndt/gfs178