Abstract
To identify demographic and clinical characteristics associated with failure to achieve hemoglobin levels ≥11 g/dl in prevalent pediatric end-stage renal disease (ESRD) patients, a cross-sectional analysis of patient clinical data collected by the Mid-Atlantic Renal Coalition in conjunction with the 2000 and 2001 ESRD Clinical Performance Measures Projects was performed. Ninety-nine patients (mean age 12.6 years, SD 5.4) contributed 119 observations to this analysis. Of patients on hemodialysis, 36.6% were anemic, and 39.5% of patients on peritoneal dialysis (PD) were anemic. Associations between age, race, gender, assigned cause of ESRD, Kt/V, transferrin saturation, time on dialysis, serum albumin, dialysis modality, and the achievement of target hemoglobin were examined. In multivariate logistic regression analyses examining age, dialysis modality, time on dialysis, and serum albumin, each 1-year increase in age was significantly associated with hemoglobin levels <11 g/dl [adjusted odds ratio (OR) 1.18, 95% confidence interval (CI) 1.06–1.32] and PD patients were more than twice as likely to have hemoglobin levels <11 g/dl (adjusted OR 2.62, 95% CI 0.98–7.04). Patients on dialysis for 6 months or more were less likely to be anemic than those on dialysis for less than 6 months (adjusted OR 0.39, 95% CI 0.16–0.99). In conclusion, increasing age, dialysis for less than 6 months, and treatment with PD were predictive of anemia in this population.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
ESRD Clinical Performance Measures Project (2001) 2000 Annual Report. Am J Kidney Dis 37[Suppl 3]:S1–S73
ESRD Clinical Performance Measures Project (2002) 2001 Annual Report. Am J Kidney Dis 39[Suppl 3]:S4–S98
Frankenfield DL, Neu AM, Warady BA, Watkins SL, Friedman AL, Fivush BA (2002) Adolescent hemodialysis: results of the 2000 ESRD Clinical Performance Measures Project. Pediatr Nephrol 17:10–15
Mitsnefes MM, Daniels SR, Schwartz SM, Meyer RA, Khoury P, Strife CF (2000) Severe left ventricular hypertrophy in pediatric dialysis: prevalence and predictors. Pediatr Nephrol 14:898–902
Chavers BM, Schnaper HW (2001) Risk factors for cardiovascular disease in children on maintenance dialysis. Adv Ren Replace Ther 8:180–190
Stefanidis CJ, Koulieri A, Siapera D, Kapogiannis A, Mitsioni A, Michelis K (1992) Effect of the correction of anemia with recombinant human erythropoietin on growth of children treated with CAPD. Adv Perit Dial 8:460–463
Baraldi E, Montini G, Zanconato S, Zacchello G, Zacchello F (1990) Exercise tolerance after anemia correction with recombinant human erythropoietin in end-stage renal disease. Pediatr Nephrol 4:623–626
Evans RW, Rader B, Manninen DL, Cooperative Multicenter EPO Clinical Trial Group (1990) The quality of life of hemodialysis recipients treated with recombinant human erythropoietin. JAMA 263:825–830
IV. NKF-K/DOQI Clinical Practice Guidelines for Anemia of Chronic Kidney Disease: update 2000 (2001) Am J Kidney Dis 37 [Suppl 1]:S182–S238
Foley RN, Parfrey PS, Harnett JD, Kent GM, Murray DC, Barre PE (1996) The impact of anemia on cardiomyopathy, morbidity, and mortality in end-stage renal disease. Am J Kidney Dis 28:53–61
Steven L, Stigant C, Levin A (2002) Should hemoglobin be normalized in patients with chronic kidney disease? Semin Dial 15:8–13
Schroder CH, The European Pediatric Peritoneal Dialysis Working Group (2003) The management of anemia in pediatric peritoneal dialysis patients. Pediatr Nephrol 18:805–809
StataCorp (2000) Stata Statistical Software: release 7.0, Stata Corporation, College Station, Texas
I. NKF-K/DOQI Clinical Practice Guidelines for Hemodialysis Adequacy: update 2000 (2001) Am J Kidney Dis 37 [Suppl 1]: S7–S64
II. NKF-K/DOQI Clinical Practice Guidelines for Peritoneal Dialysis Adequacy: update 2000 (2001) Am J Kidney Dis 37 [Suppl 1]:S65–S136
Blagg CR, Liedtke RJ, Batjer JD, Racoosin B, Sawyer TK, Wick MJ, Lawson L, Wilkens K (1993) Serum albumin concentration-related Health Care Financing Administration quality assurance criterion is method-dependent: revision is necessary. Am J Kidney Dis 21:138–144
Frankenfield DL, Neu AM, Warady BA, Fivush BA, Johnson CA, Brem AS (2003) Anemia in pediatric hemodialysis patients: results from the 2001 ESRD Clinical Performance Measures Project. Kidney Int 64:1120–1124
Matsui DM (1997) Drug compliance in pediatrics. Clinical and research issues. Pediatr Clin North Am 44:1–14
Tebbi CK (1993) Treatment compliance in childhood and adolescence. Cancer 71 [Suppl]:3441–3449
Chigier E (1992) Compliance in adolescents with epilepsy or diabetes. J Adolesc Health 13:375–379
Meyers KEC, Weiland H, Thomson PD (1992) Paediatric renal transplantation non-compliance. Pediatr Neprol 9:189–192
Rocco MV, Bedinger MR, Milam R, Greer JW, McClellan WM, Frankenfield DL (2001) Duration of dialysis and its relationship to dialysis adequacy, anemia management, and serum albumin level. Am J Kidney Dis 38:813–823
Acknowledgements
We acknowledge the assistance of CMS and its contractor MARC in providing the data for this research. The content of this paper does not necessarily reflect the views or policies of the Department of Health and Human Services, CMS, or MARC. These data were published in abstract form in the 2002 JASN Program and Abstract Issue (SU-P0753).
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Fadrowski, J.J., Furth, S.L. & Fivush, B.A. Anemia in pediatric dialysis patients in End-Stage Renal Disease Network 5. Pediatr Nephrol 19, 1029–1034 (2004). https://doi.org/10.1007/s00467-004-1544-7
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00467-004-1544-7