nephronline - Long title

Paediatric Addendum to the Anaemia Chapter

Introduction

Following is a short paediatric addendum, produced by Professor Stewart Cameron, to the chapter on the management of anaemia in patients with chronic renal failure. We would welcome comments on any aspect. I would be most grateful for comments on any aspects of the chapter to be e-mailed to me at mmd175@abdn.ac.uk. We look forward to hearing your comments. Thank you for your interest.

Alison MacLeod Chairman, Standards & Audit Subcommittee of the Renal Association.

Anaemia in children with CRF has additional importance as it may adversely affect appetite and growth. Correction of anaemia improves nutritional intake and is associated with improvement in growth, although this has not been shown in a controlled trial¹ (B).

Standards

Target Haemoglobin: all children with CRF and on dialysis should achieve their target haemoglobin within 12 weeks of seeing a paediatric nephrologist, unless there is a specific reason. Targets are age specific, as below:

	children under six months of age should achieve a haemoglobin of greater than or equal to 9.5g/dl.
	children aged six months to two years should achieve a haemoglobin of greater than or equal to 10.0g/dl.
	children over two years of age should achieve a haemoglobin of greater than or equal to 10.5g/dl. (Evidence level B)

Adequate iron status: all children should achieve a serum ferritin of greater than or equal to 100µg/l and less than 800µg/l, whether or not they are receiving erythropoietin. (B)

Recommendations

		evaluation of anaemia: the haemoglobin rises throughout childhood as follows: normal range (+/- 2SD) before six months of age is 11.5 (9.5-13.5) g/dl; from six months to 2 years is 12.0 (10.5-13.5) g/dl; and rises progressively to 13.5 (11.5-15.5) g/dl by 12 years. Evaluate for anaemia when the haemoglobin falls to <10g/dl before 6 months of age, <11gm/dl from 6 months to 2 years, and <12g/dl in older children.
		iron administration: persistently low ferritin despite oral supplementation is an indication for intravenous iron therapy. Side effects must be monitored.
		haemoglobin concentration should be monitored 1 to 2 monthly.
		iron status should be monitored three-monthly.

Background

Erythropoietin is effective in children in improving the anaemia of CRF and dialysis and in children with failing renal transplants¹. Erythropoietin doses in children are comparable on a unit/kg basis to adult requirements² and have been shown to be safe. Subcutaneous injection is the most bioavailable route of administration. Dosage intervals can be determined by response, but are usually once to twice weekly³. Iron and folic acid supplementation is required.

References

1. Jabs K. The effects of recombinant human erythropoietin on growth and nutritional status. Pediatr Nephrol 1996;10:324-7

2. Brandt JR. Safety and efficacy of erythropoietin in children with chronic renal failure. Pediatr Nephrol 1999;13:143-7

3. Van Damme-Lombaerts R, Herman J. Erythropoietin treatment in children with renal failure. Pediatr Nephrol 1999; 13:148-52

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We would very much like your comments on this document

Please send them to Alison MacLeod, Chairman, Standards & Audit Subcommittee of the Renal Association, at: mmd175@abdn.ac.uk