P. Rendo et al., TREATMENT OF ANEMIA IN CHILDREN UNDERGOIN G CHRONIC-HEMODIALYSIS WITHRECOMBINANT-HUMAN-ERYTHROPOIETIN, Medicina, 54(5), 1994, pp. 392-398
Anemia associated to chronic renal failure (CRF) is a very frequent di
sorder. Twenty five per cent of adult patients under hemodialysis requ
ire periodical transfusions to maintain acceptable quality of life. Th
is anemia is due mainly to a relative deficit of erythropoietin (EPO).
Thanks to recombinant DNA techniques, EPO availability has made it po
ssible to treat this population with the hormone. Most of the reported
experience has been obtained from adult patients and literature on ch
ildren is scarce. For this reason, a controlled prospective trial on 1
8 patients (9 males and 9 females) with a mean age of 12.4 years (rang
e 7-17) was conducted, evaluating hematimetric response, safety of tre
atment and effect on quality of life after one year of treatment. Seve
nteen patients could be evaluated; mean follow-up was of 365 days (180
-323). Treatment started with an administration scheme of 25 U/kg/ dos
e, i. v. route, three times weekly, and dose was corrected according t
o the hematimetric response. Target hemoglobin was set in 10g%. Mean d
ose required to reach target was 101.5 +/- 37.7 U/kg/dose (50-200) thr
ee times weekly and time elapsed was of 223.3 days (175-355). Only one
patient did not achieve target hemoglobin value with the maximal dose
planned (200 U/kg/dose). Bone marrow biopsy in this patient showed a
widespread fibrosis secondary to hyperparathyroidism caused by CRF. Di
rect correlation was found between the required rHuEPO dose and basal
levels of serum alkaline phosphatase (Table 2). Results obtained in st
atus performance on six patients showed significant increase in all th
e variables under analysis (Table 4). The most frequently found side e
ffect was exacerbation of arterial hypertension, observed in 35% of pa
tients (Table 5). Briefly, rHuEPO was effective to correct anemia in c
hildren, showing few side effects and improving life quality parameter
s. According to our experience, secondary hyperparathyroidism was the
most frequent cause of resistance to treatment. Therefore, proper medi
cal care before rHuEPO treatment is recommended.