Abstract: SA-PO809

Effects of Adult Erythropoietin Dosing Regimens on Pediatric Dosing Practice: Findings from North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS)

Session Information

Category: Dialysis

  • 605 Dialysis: Anemia and Iron Metabolism

Authors

  • Twichell, Sarah A., University of Vermont Children's Hospital, Burlington, Vermont, United States
  • Hunt, Elizabeth A.K., University of Vermont Children's Hospital, Burlington, Vermont, United States
  • Martz, Karen, NAPRTCS, Rockville, Maryland, United States
  • Somers, Michael J., Boston Children's Hospital, Boston, Massachusetts, United States
Background

Development of recombinant erythropoietin (epo) led to declines in anemia among hemodialysis (HD) patients, but studies showed more morbidity in adult HD patients with a ‘normal’ hemoglobin (hgb) level, so 2008 adult guidelines recommended target hgb <11.5 gm/dL. Adult guidelines are often applied to pediatric dialysis patients, though increased morbidity with higher hgb levels has not been demonstrated in children. We evaluated transfusions and anemia among pediatric HD patients before and after adult anemia guideline implementation.

Methods

We performed a retrospective analysis of children in the NAPRTCS database, a voluntary, prospective registry of children with end stage renal disease. We assessed transfusions, anemia, epo dosing, and hospitalizations in 3 time periods: baseline (2003-2007), implementation (2008-2011) and post-implementation (2012-2016). Children were included once in the earliest period enrolled.

Results

1,199 children enrolled in the NAPRTCS HD registry during the study period (54.7% male, median age 13.4 years). Children in post-implementation were significantly younger than children in baseline and implementation. 12.8% of patients had transfusions in baseline, 19.6% in implementation (p=0.008 vs. baseline), and 17.4% in post-implementation (p=0.08 vs. baseline). Mean hgb 6 months after HD start was 11.8 gm/dL in baseline, 11.1 gm/dL in implementation (p<0.001 compared with baseline) and 11 gm/dL in post-implementation (p<0.02 compared with baseline). Median epo dosing 6 months after starting HD was 211 u/kg/week in baseline, 131 u/kg/week in implementation, and 142 u/kg/week in post-implementation. 6 months after starting dialysis, 42.7% of children were hospitalized in baseline, 43.4% in implementation, and 46.5% in post-implementation. The rate of anemia (hgb <10) 6 months after starting dialysis was 17.4% in baseline, 23.5% in implementation, and 23.8% in post-implementation.

Conclusion

With implementation of adult epo dosing guidelines, epo dosing was lower, anemia rate increased, transfusion rate increased, and mean hgb levels decreased among NAPRTCS participants. There was no significant difference in hospitalization rates before and after guidelines. Further study of safe target hgb levels among pediatric HD patients is warranted.