Background:
Despite improvements in dialysis care, anemia remains a problem in pediatric hemodialysis patients.
Methods:
To assess possible explanations for the anemia, clinical data were obtained from the centers for medicare and medicaid services on all hemodialysis patients ages 12 to <18 years between october and december 2000. complete data were available for 435 of the 516 patients (84%).
Results:
A total of 160 (37%) patients had a mean hemoglobin of <11 g/dl (anemic). the mean (+/- sd) age for these patients was 15.5 +/- 1.8 years compared to 15.9 +/- 1.5 years for the target hemoglobin patients (p < 0.05). mean time on chronic dialysis was similar for both the anemic and target hemoglobin patients (>/=100 g/dl) ( approximately 3 years) but patients on dialysis <6 months were more likely to be anemic (67%). while nearly all patients were treated with erythropoietin, anemic patients received greater weekly erythropoietin doses (intravenous, anemia 374 +/- 232 units/kg/week vs. target hemoglobin 246 +/- 196 units/kg/week, p < 0.001; and subcutaneous, 304 +/- 238 units/kg/week vs. 167 +/- 99 units/kg/week, p < 0.05). a total of 59% of anemic patients had a mean transferrin saturation (tsat) >/=20% compared to 71% of patients with a target hemoglobin (p < 0.01). a mean serum ferritin >/=100 ng/ml was present in approximately two thirds of the anemic and target hemoglobin patients. approximately 60% of all children were treated with intravenous iron. the mean kt/v values were lower for anemic patients (1.46 +/- 0.4 vs. 1.53 +/- 0.3, p < 0.05). anemic patients were less likely to have a normal serum albumin (29% anemic vs. 52% target hemoglobin patients, p < 0.001).
Conclusion:
In the final multivariable regression model, dialyzing <6 months, a low albumin, and a mean tsat <20% remained significant predictors of anemia in children.