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2011 | 7 | 2 | 156-163
Article title

Leczenie czynnikami pobudzającymi erytropoezę u dzieci z przewlekłą chorobą nerek w 3.-5. stadium – wyniki ogólnopolskiego badania wieloośrodkowego Polskiego Towarzystwa Nefrologii Dziecięcej

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Title variants
EN
Treatment with erythropoiesis stimulating agents in children with chronic kidney disease (3‑5) – Polish Society of Paediatric Nephrology multicentre analysis
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EN PL
Abstracts
EN
Introduction: Erythropoiesis-stimulating agents (ESA) are applied as a standard therapy in patients with anaemia in chronic kidney disease in children. There is scarce data on factors influencing ESA treatment efficacy in this population. The aim of our study was to describe the efficacy and details of ESA treatment in population CKD children (3.5) in Poland. Material and methods: The study has a prospective observational design and was performed in 12 dialysis centres for children in Poland. The analysis started on 1 Nov 2008 and lasted for the following 6 months. We analysed basic clinical and anthropometric data, details of renal replacement therapy with its modality, efficacy (KT/V) and duration, ESA (dose, administration), iron (concentration, storage, supplementation). Detailed analysis of anaemia was performed (haemoglobin, transferrin, ferritin concentration) at 1 month interval according to the local requirements. Results: The study group comprised 117 dialysed children and 35 children in predialysis period. The study showed that most of the dialysed children were treated with epoietin beta, despite the treatment modality. The mean dose of EPO was 99 (68.147) IU/kg/week for dialysed and 77 (43.98) for non-dialysed subjects. Mean haemoglobin concentration was 10.9}1.6 g/dl on dialysis and 11.2}1.1 g/dl in predialysis. The efficacy of anaemia treatment was unsatisfactory with 52% of undertreated dialysis subjects, whereas in predialysis 71% children achieved the target level. In multivariate analysis initial haemoglobin level >10 g/l (above median level), any infection, age at first dialysis and erythropoietin dose remained significant (predictors) of anaemia in dialysed children. Conclusion: We revealed that the anaemia treatment in Polish children is unsatisfactory. Late commencing the treatment, dosing based on adult formula (IU/kg/week) and infections could constitute risk factors for therapy failure.
PL
Wstęp: Choć czynniki stymulujące erytropoezę (ESA) są stosowane od wielu lat w leczeniu niedokrwistości nerkopochodnej u chorych ze schyłkową niewydolnością nerek, niewiele jest badań oceniających skuteczność takiego leczenia u dzieci. Celem pracy była ocena skuteczności leczenia ESA u dzieci z przewlekłą chorobą nerek w Polsce, zarówno w okresie przeddializacyjnym, jak i dializacyjnym. Materiał i metoda: Badanie prospektywne, prowadzone od 1.11.2008 do 30.04.2009 r., ankietowe. Ankiety rozesłano do 12 ośrodków prowadzących leczenie dzieci z PChN zarówno dializami, jak i w okresie przeddializacyjnym. Pytania dotyczyły między innymi podstawowych danych chorego, przyczyny choroby nerek, wieku rozpoczęcia leczenia dializacyjnego, rodzaju stosowanej erytropoetyny, suplementacji żelaza, stężenia hemoglobiny. Wyniki: Analizą objęto 117 dzieci leczonych dializami i 35 w okresie przeddializacyjnym. W obu grupach stosowano głównie erytropoetynę beta (odpowiednio 74% i 77%) – mediana odpowiednio 99 (62‑142) i 77 (43‑98) IU/kg/tydzień. Średnie stężenie hemoglobiny wynosiło 10,9±1,6 g/dl u dzieci dializowanych i 11,2±1,1 g/dl w predializie. W grupie dializowanych 48% osiągnęło zalecane wartości hemoglobiny, w grupie leczonych zachowawczo – 71%. Wnioski: Badanie wykazało niedostateczną skuteczność leczenia niedokrwistości nerkopochodnej prou dializowanych dzieci w Polsce. Obecność zakażenia, zaawansowanie niedokrwistości na początku leczenia oraz niedostatecznie wysoka dawka erytropoetyny były czynnikami ryzyka niepowodzenia leczenia.
Discipline
Year
Volume
7
Issue
2
Pages
156-163
Physical description
References
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article
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bwmeta1.element.psjd-53117b81-a149-496b-858b-a114ac8d5d10
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