Recombinant erythropoietin in children under hemodialysis

Abstract

Recornbinant human erythropoietin (rh-EPO) was used in five patients aged 5 to 11 years, under hemodialysis because of chronic renal failure, along three to six months periods, in individual doses of 20 to 30 U subcutaneously two to three times a week, depending on their hemodialysis schedule, aiming to sustain 30% hematocrit and 1 0 g/dl hemoglobin levels. Significant weekly mean hematocrit increases of 0.41 vol% (range 0.33 - 0.55, p < 0.05) were observed in all patients. Two children were given a renal transplant at the fourth month of treatment. In one patient who was withdrawn from the study because of high blood pressure and seizures in the third month of therapy, hematocrit increased from 14 to 20 vol% in that same period. All patients had high serum iron and ferritin at the begining of the trial, probably because of blood transfusion related iron overload. Serum iron fell but serum ferritin remained elevated by the end of the treatment. Transfusion were no longer needed in all patients after the second month of rh-EPO therapy. The urea kinetics and phosphate and calcium metabolism were not changed during treatment. Serum PTH levels were high at the begining of the study in all patients. Body composition was improved at the end of treatment which was most significant for the fat mass. One hipertensive patient required higher doses of antihypertensive drugs and in another two it was necessary to increase heparin doses during dialysis. We did not observe trombus neither echymoses formation secondary to the puncture at the site of the arteriovenous fistula. Recombinant erythropoietin seems to be an excellent alternative for treatment of anemia in patients under hemodialysis for chronic renal failure.