ERYTHROPOIETIN TREATMENT OF ANEMIA ASSOCIATED WITH CHRONIC-RENAL-FAILURE IN CHILDREN

Over the last six years recombinant human erythropoietin (rhEPO) has i ncreasingly been used to effectively and safely treat anemia associate d with chronic renal failure (CRF) in children. This so-called renal a nemia (RA) is mainly induced by a reduced erythropoiesis, nearly exclu sively due to an insufficient secretion of EPO. Treatment with rhEPO, characterized by a low risk-benefit-ratio, has changed the life of chi ldren with CRF in a revolutionary manner by: a) the establishment of a constantly normal hemoglobin (Kb) concentration leading to normal tis sue oxygenation which has been shown to improve cardiac and cognitive function, exercise tolerance, well-being and appetite. b) the avoidanc e of blood transfusion including the risk of transmission of infection s (e.g. hepatitis C), hemosiderosis, HLA-antibody sensitization, and s uppression of erythropoiesis. Suppression of renal function deteriorat ion and improved linear body growth are characteristic features of chi ldren with RA and preterminal CRF treated with rhEPO. Hypertension (HB P) is a frequent and potentially serious side effect. Hyperkalemia, hy perphosphatemia and thrombocytosis have also been observed. Three subc utaneous injections per week mimic physiologic conditions best. The re sponse to treatment achieved within a mean interval of 2 months at dos es ranging between 125-325 U/kg/wk should be followed by maintenance t reatment with a target Hb of 11.5-13.5 g/dl. Due to the increased dema nd of iron during rhEPO therapy, iron deficiency either absolute or fu nctional is the usual reason for poor response. This can be overcome b y either oral or intravenous iron supplementation. rhEPO treatment sho uld not be started until conditions predicting poor response are exclu ded (e.g. Fe deficiency, hyperparathyroidism, aluminum overload, infec tion) and should be subsequently monitored according to parameters of effectiveness (e.g. Hb, reticulocytes) and side-effects (e.g. blood pr essure, potassium level, platelets).