LOW-DOSE ERYTHROPOIETIN IS EFFECTIVE AND SAFE IN CHILDREN ON CONTINUOUS AMBULATORY PERITONEAL-DIALYSIS

Hypertension is one of the most important complications of erythropoie tin (rHuEPO) therapy in dialysis patients. In this study, the effect o f two different dosage regiments of subcutaneous rHuEPO on blood press ure [BP] was evaluated in 20 anemic children on continuous ambulatory peritoneal dialysis (CAPD). Patients were randomized to receive rHuEPO 50 U/kg, either once a week (group 1, 50 U/kg per week) or three time s a week (group 2, 150 U/kg per week). At the beginning of the study, 8 patients in group 1 and 8 patients in group 2 were on antihypertensi ve therapy. In group 1, the hematocrit increased gradually and signifi cantly from 18.98% +/- 1.79% to 30.1% +/- 1.62% after 6 months, while in group 2 it rapidly increased from 19.53% +/- 1.86% to 32.4% +/- 1.1 1% after 3 months. A significant increase in the mean arterial BP was observed in group 2. Antihypertensive therapy had to be increased in a ll of the 8 previously hypertensive patients and had to be initiated i n 1 of the 2 originally normotensive patients in the same group. None of the patients in group 1 required a change in antihypertensive medic ation. We conclude that during treatment with rHuEPO preexisting hyper tension and the dose of rHuEPO are the most important risk factors for the development or worsening of hypertension in children on CAPD, and gradual elevation of hematocrit by low-dose rHuEPO avoids the develop ment of severe hypertension.