Association of higher erythropoiesis stimulating agent dose and mortality in children on dialysis

作者：Lestz Rachel M^*; Fivush Barbara A; Atkinson Meredith A

来源：Pediatric Nephrology, 2014, 29(10): 2021-2028.

DOI：10.1007/s00467-014-2820-9

• Hemoglobin
• Anemia
• Death
• Epogen
• Darbepoetin alfa

Higher doses of erythropoiesis-stimulating agents (ESA) have been associated with an increased risk of adverse outcomes in adults with chronic kidney disease (CKD) and end-stage kidney disease (ESRD), but to our knowledge no trials have been performed in children. We examined the association between ESA dose and all-cause mortality in a prevalent pediatric dialysis population.
Retrospective cohort study utilizing national data on all prevalent dialysis patients aged < 18 years from the Centers for Medicare and Medicaid Services' 2005 ESRD Clinical Performance Measures (CPM) project, linked to 18-month mortality records from the United States Renal Data System. Multivariate Cox proportional hazards regression was performed to determine the risk of mortality by mean weekly ESA dose.
Eight-hundred and twenty-nine children were included in the analysis; 7 % died during follow-up. A higher proportion of patients receiving ESA doses in the highest category (erythropoietin a parts per thousand yen350 units/kg/week or darbepoetin a parts per thousand yen1.5 units/kg/week) died (50 % vs 28 %, p = 0.002), and also demonstrated a trend toward lower hemoglobin (11.0 vs 11.4 g/dL, p = 0.05). In multivariate analysis, patients receiving the highest dose of ESA demonstrated an increased risk of mortality (hazard ratio 3.37; p value < 0.01).
Higher ESA dose is independently associated with mortality in children on chronic dialysis.

• 出版日期2014-10