Van dop C, Jabs KL, Alexander SA, Salusky IB, McCabe D
Correction of anemia does not improve growth or endocrine
function in children with ESRD: A report from the U.S.
multicenter pediatric recombinant erythropoietin study
Am Soc Nephrol
J Am Soc Nephrol (abstract)
(Nov) 6:407 1995
Conventional wisdom has held that treatment of anemia in
children with ESRD is important in sustaining proper growth.
This study of 48 children on HD (age 14.3+/-3.1, mean Hct 22+/3)
and 56 children on PD (age 10+/5.7, mean Hct 21+/4) suggests,
however, that EPO did not help at the end of the 3 year
follow-up period. A goal Hct of 31+/5 was used. Unfortunately
this study was not truly case controlled, as only half of all
patients were treated with placebo for 12 weeks before EPO
treatment. No statistically significant improvement was
detected in age-adjusted standard deviation score for height or
weight (head circumference/weight-for-height in children less than 2 years of
age. In addition, IGF-1 and IGF-binding protein concentrations were not
improved with EPO. Finally, thyroid hormones, sex steroids and
gonadotropins were age appropriate and unaffected by treatment.
Perhaps normal rather than sub-physiologic hematocrit goals will
prove to be important in achieving desired growth.
Additional comments by Steven Fishbane: The treatment of
children with ESRD with EPO may lead to improvements in
growth, however, studies to date have yielded inconsistent results. This
trial followed 113 children with a mean age of 14.3 years (HD) and 10.0
years
(PD). All were treated for 36 weeks with EPO, but 50% first received placebo
for 12 weeks. The primary result was no change in standard deviation from
the
norm in height or weight with EPO therapy. This is an interesting negative
study, however, the results would be
much more powerful if it was of a randomized controlled design. There really
was no control group in this study.
(Narsipur)
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Am Soc Nephrol
CRF by problem area :
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CRF in infants and children