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Çocuk Diyaliz Hastalarında Anemi ve Aluminyum Düzeyleri

Year 2019, Volume: 3 Issue: 3, 79 - 84, 03.12.2019

Abstract

ÖZ

Amaç: Kronik böbrek
yetmezliği (KBY) glomerüler filtrasyon hızında geri dönüşsüz azalma olarak
tanımlanır. Kronik böbrek yetmezliğinde evre ilerledikçe anemi prevalansı %90’a
kadar ulaşır. Aneminin rekombinan insan eritropoetini (rHuEPO) ile
düzeltilemediği durumlarda, diyaliz yeterliliğinin, inflamasyonun, vitamin
düzeylerinin, hiperparatiroidinin, kan kayıplarının, kullanılan ilaçların,
serum aluminyum (Al) düzeyinin araştırılması gerekmektedir. Çalışmamızda
pediatrik diyaliz hastalarında anemi nedenlerini araştırmayı hedefledik.

Araçlar ve Yöntem: Bu kesitsel
prospektif çalışma periton diyalizi (PD) veya hemodiyaliz (HD) uygulanan çocuk
hastalarda yapıldı

Bulgular: : Çalışmaya toplam
49 hasta (K/E=27/22) alındı. Hastaların yaş ortalaması 12.65 (0.16-20) yıl,
ortalama diyaliz süresi 28 ay (1-108) idi. 35 hasta (%71.4) PD, 14 hasta
(%28.6) HD programında idi. Hastaların 37’sinde (%75.5) anemi saptandı. Anemik
hastaların ortalama Hemoglobin (Hb) 8.85
±1.18 g/dl, Ortalama
Eritrosit Volümü (OEV) 86.40
±5.01 fl bulundu.
Hemodiyaliz ve PD gruplarında sırasıyla ferritin ortalaması 831.35 (
±545.05) ng/ml ve
450.05 (
±313.15 ng/ml) bulundu (p=0.005).
Hastaların 7’si (%14.3) intravenöz (iv) demir, 24’ü (%49) oral demir preparatı
kullanmaktaydı. Parenteral demir kullanan hastalarda Hb ve ferritin düzeyleri
istatistiksel olarak anlamlı yüksekti (p<0.05). Kırkdokuz hastanın 42’si EPO
tedavisi kullanmaktaydı, EPO kullanma durumuna göre hastaların Hb düzeyleri
arasında fark bulunmadı. Serum Al düzeyi 37 hastada bakıldı. Hastaların
tamamının Al düzeyi güvenli sınırlar içindeydi.









Sonuç: Hastalarımızın
%63’ü demir, %85.7’si EPO tedavisi kullanmalarına rağmen, %75 sıklıkta anemik
olduklarını saptadık. Çalışmamızda, diyaliz hastalarımızın hiçbirinde Al
birikimi olmadığını gördük. Çocuk diyaliz hastalarında tedaviye rağmen anemi
sıklığının yüksek olmasının nedenlerine yönelik yapılacak daha kapsamlı
prospektif çalışmalar, hastaların bireysel tedavilerinin planlanmasına yardımcı
olacaktır.

References

  • 1. National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002 Feb;39(2 Suppl 1):S1-266.
  • 2. Gerson AC, Butler R, Moxey-Mims M, et al. Neurocognitive outcomes in children with chronic kidney disease: Current findings and contemporary endeavors. Ment Retard DevDisabil Res Rev. 2006;12(3):208-15. Review.
  • 3. Roumelioti ME, Wentz A, Schneider MF, et al. Sleep and fatigue symptoms in children and adolescents with CKD: a cross-sectional analysis from the chronic kidney disease in children(CKiD) study. Am J Kidney Dis. 2010 Feb;55(2):269-80. doi:10.1053/j.ajkd.2009.09.021. Epub 2010 Jan 19.
  • 4. Pickett JL, Theberge DC, Brown WS, Schweitzer SU, Nissenson AR. Normalizing hematocrit in dialysis patients improves brain function. Am J Kidney Dis. 1999Jun;33(6):1122-30.
  • 5. Atkinson MA, Warady BA. Anemia in chronic kidney disease. Pediatr Nephrol.2018 Feb;33(2):227-238.
  • 6. Fadrowski JJ, Furth SL, Fivush BA. Anemia in pediatric dialysis patients inend-stage renal disease network 5. Pediatr Nephrol. 2004 Sep;19(9):1029-34. Epub 2004 Jul 6.
  • 7. Müller-Wiefel DE, Sinn H, Gilli G, Schärer K. Hemolysis and blood loss inchildren with chronic renal failure. Clin Nephrol. 1977 Nov;8(5):481-6.
  • 8. Warady BA, Schaefer F, Alexander SR (eds): Pediatric Dialysis, ed 2. New York, Springer, 2012, pp xix, 825
  • 9. Atkinson MA, Warady BA. Anemia in chronic kidney disease. Pediatr Nephrol. 2018 Feb;33(2):227-238
  • 10. Group KDIGOKAW. KDIGO Clinical Practice Guidelines for Anemia in Chronic Kidney Disease. Kidney Int Suppl. 2012;2:279–335.
  • 11. KDOQI. KDOQI Clinical Practice Guideline and Clinical Practice Recommendations for anemia in chronic kidney disease: 2007 update of hemoglobin target. Am J Kidney Dis. 2007;50:471–530.
  • 12. Gaweda AE. Markers of iron status in chronic kidney disease. Hemodial Int. 2017 Jun;21Suppl 1:S21-S27. doi: 10.1111/hdi.12556. Epub 2017 Mar 22. Review.
  • 13. Kooistra MP, Niemantsverdriet EC, van Es A, Mol-Beermann NM, Struyvenberg A,Marx JJ. Iron absorption in erythropoietin-treated haemodialysis patients:effects of iron availability, inflammation and aluminium. Nephrol Dial Transplant. 1998 Jan;13(1):82-8.
  • 14. Drüeke TB. Anemia treatment in patients with chronic kidney disease. N Engl J Med. 2013 Jan 24;368(4):387-9. doi: 10.1056/NEJMe1215043.
  • 15. Koshy SM, Geary DF. Anemia in children with chronic kidney disease. Pediatr Nephrol. 2008 Feb;23(2):209-19. Epub 2007 Jan 24. Review.
  • 16. Paglialonga F, Consolo S, Pecoraro C, et al. Chronic haemodialysis in small children: a retrospective study of the Italian Pediatric Dialysis Registry. Pediatr Nephrol. 2016 May;31(5):833-41.
  • 17. Krause I, Davidovits M, Tamary H, Yutcis M, Dagan A. Anemia and markers of erythropoiesis in pediatric kidney transplant recipients compared to children with chronic renal failure. Pediatr Transplant. 2016 Nov;20(7):958-962.
  • 18. Bennett CL, Cournoyer D, Carson KR, et al. Long-term outcome of individuals with pure red cell aplasia and antierythropoietin antibodies in patients treated withrecombinant epoetin: a follow-up report from the Research on Adverse Drug Events and Reports (RADAR) Project. Blood. 2005 Nov 15;106(10):3343-7.
  • 19. Casadevall N, Nataf J, Viron B, et al. Pure red-cell aplasiaand antierythropoietin antibodies in patients treated with recombinant erythropoietin. N Engl J Med. 2002 Feb 14;346(7):469-75.
  • 20. Borzych-Duzalka D, Bilginer Y, Ha IS, et al; International Pediatric Peritoneal Dialysis Network (IPPN) Registry. Management of anemia in children receiving chronic peritoneal dialysis.J Am Soc Nephrol. 2013 Mar;24(4):665-76.
  • 21. Jaffe JA, Liftman C, Glickman JD. Frequency of elevated serum aluminum levels in adult dialysis patients. Am J Kidney Dis. 2005 Aug;46(2):316-9.
  • 22. National Kidney Foundation, Kidney Disease Outcomes Quality Initiative. Guideline 11: aluminum overload and toxicity in CKD. Guideline 12: treatment of aluminum toxicity. In: K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. New York, NY: National Kidney Foundation; 2003. Available at http://www.kidney.org/professionals/kdoqi/guidelines_bone/index.htm.
  • 23. Centers for Disease Control and Prevention (CDC). Elevated serum aluminum levels in hemodialysis patients associated with use of electric pumps--Wyoming, 2007. MMWR Morb Mortal Wkly Rep. 2008 Jun 27;57(25):689-91.
  • 24. Alexander S, Benfield M, Fine R. North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) 2002 Annual Report; 2002.

Anemia and Aluminium Levels in Child Patients with Dialysis

Year 2019, Volume: 3 Issue: 3, 79 - 84, 03.12.2019

Abstract

ABSTRACT

Purpose: Chronic renal failure (CRF) is defined as
irreversible reduction in glomerular filtration rate. In chronic renal failure,
the prevalence of anemia reaches up to 90% as the stage progresses. In cases
where the anemia can not be corrected with recombinant human erythropoietin
(rHuEPO), it is necessary to investigate the adequacy of dialysis, presence of
inflammation, vitamin levels, hyperparathyroidism, blood loss, drugs used and
serum aluminum (Al) level. The aim of the study was to investigate the reasons
of anemia in pediatric patients with dialysis.

Materials and Methods: Our cross-sectional prospective study was
performed in children with CRF undergoing peritoneal dialysis (PD) or
hemodyalisis (HD).

Results: A total of 49 pediatric patients (F/M=27/22)
were enrolled into the study. The mean age of patients was 12.65 (range
0.16-20) years, the mean duration of dialysis was 28 months (range 1-108), 35
patients (71.4%) were on PD and 14 patients (28.6%) were on HD program. Anemia
was detected in 37 (75.5%) of the patients. The mean Hemoglobin (Hb) was
8.85±1.18 g /dl and mean corpuscular volume was (MCV) 86.40±5.01 fl in patients
with anemia. The mean ferritin was 831.35 (±545.05) ng/ml and 450.05 (±313.15)
ng/ml in the HD and PD groups, respectively (p=0.005). Seven patients (14.3%)
were using iv iron and 24 (49%) were using oral iron preparations. Hb and
ferritin levels were significantly higher in patients using parenteral iron (p
<0.05). Forty-two patients (85.7%) were using rHuEPO, and there was no
difference in the Hb levels of patients according to the use of rHuEPO. Serum
Al levels were within safe limits in all of the 37 patients.









Conclusion: We found that 75% of our patients were anemic,
despite the fact that 63% were using iron supplementation and 85.7% were using
rHuEPO therapy. In our study, we found that none of our dialysis patients had
Al accumulation. More extensive prospective studies are warranted to highlight
the causes of high anemia frequency in childhood dialysis patients, which will
help in planning of individual treatment of anemia.

References

  • 1. National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002 Feb;39(2 Suppl 1):S1-266.
  • 2. Gerson AC, Butler R, Moxey-Mims M, et al. Neurocognitive outcomes in children with chronic kidney disease: Current findings and contemporary endeavors. Ment Retard DevDisabil Res Rev. 2006;12(3):208-15. Review.
  • 3. Roumelioti ME, Wentz A, Schneider MF, et al. Sleep and fatigue symptoms in children and adolescents with CKD: a cross-sectional analysis from the chronic kidney disease in children(CKiD) study. Am J Kidney Dis. 2010 Feb;55(2):269-80. doi:10.1053/j.ajkd.2009.09.021. Epub 2010 Jan 19.
  • 4. Pickett JL, Theberge DC, Brown WS, Schweitzer SU, Nissenson AR. Normalizing hematocrit in dialysis patients improves brain function. Am J Kidney Dis. 1999Jun;33(6):1122-30.
  • 5. Atkinson MA, Warady BA. Anemia in chronic kidney disease. Pediatr Nephrol.2018 Feb;33(2):227-238.
  • 6. Fadrowski JJ, Furth SL, Fivush BA. Anemia in pediatric dialysis patients inend-stage renal disease network 5. Pediatr Nephrol. 2004 Sep;19(9):1029-34. Epub 2004 Jul 6.
  • 7. Müller-Wiefel DE, Sinn H, Gilli G, Schärer K. Hemolysis and blood loss inchildren with chronic renal failure. Clin Nephrol. 1977 Nov;8(5):481-6.
  • 8. Warady BA, Schaefer F, Alexander SR (eds): Pediatric Dialysis, ed 2. New York, Springer, 2012, pp xix, 825
  • 9. Atkinson MA, Warady BA. Anemia in chronic kidney disease. Pediatr Nephrol. 2018 Feb;33(2):227-238
  • 10. Group KDIGOKAW. KDIGO Clinical Practice Guidelines for Anemia in Chronic Kidney Disease. Kidney Int Suppl. 2012;2:279–335.
  • 11. KDOQI. KDOQI Clinical Practice Guideline and Clinical Practice Recommendations for anemia in chronic kidney disease: 2007 update of hemoglobin target. Am J Kidney Dis. 2007;50:471–530.
  • 12. Gaweda AE. Markers of iron status in chronic kidney disease. Hemodial Int. 2017 Jun;21Suppl 1:S21-S27. doi: 10.1111/hdi.12556. Epub 2017 Mar 22. Review.
  • 13. Kooistra MP, Niemantsverdriet EC, van Es A, Mol-Beermann NM, Struyvenberg A,Marx JJ. Iron absorption in erythropoietin-treated haemodialysis patients:effects of iron availability, inflammation and aluminium. Nephrol Dial Transplant. 1998 Jan;13(1):82-8.
  • 14. Drüeke TB. Anemia treatment in patients with chronic kidney disease. N Engl J Med. 2013 Jan 24;368(4):387-9. doi: 10.1056/NEJMe1215043.
  • 15. Koshy SM, Geary DF. Anemia in children with chronic kidney disease. Pediatr Nephrol. 2008 Feb;23(2):209-19. Epub 2007 Jan 24. Review.
  • 16. Paglialonga F, Consolo S, Pecoraro C, et al. Chronic haemodialysis in small children: a retrospective study of the Italian Pediatric Dialysis Registry. Pediatr Nephrol. 2016 May;31(5):833-41.
  • 17. Krause I, Davidovits M, Tamary H, Yutcis M, Dagan A. Anemia and markers of erythropoiesis in pediatric kidney transplant recipients compared to children with chronic renal failure. Pediatr Transplant. 2016 Nov;20(7):958-962.
  • 18. Bennett CL, Cournoyer D, Carson KR, et al. Long-term outcome of individuals with pure red cell aplasia and antierythropoietin antibodies in patients treated withrecombinant epoetin: a follow-up report from the Research on Adverse Drug Events and Reports (RADAR) Project. Blood. 2005 Nov 15;106(10):3343-7.
  • 19. Casadevall N, Nataf J, Viron B, et al. Pure red-cell aplasiaand antierythropoietin antibodies in patients treated with recombinant erythropoietin. N Engl J Med. 2002 Feb 14;346(7):469-75.
  • 20. Borzych-Duzalka D, Bilginer Y, Ha IS, et al; International Pediatric Peritoneal Dialysis Network (IPPN) Registry. Management of anemia in children receiving chronic peritoneal dialysis.J Am Soc Nephrol. 2013 Mar;24(4):665-76.
  • 21. Jaffe JA, Liftman C, Glickman JD. Frequency of elevated serum aluminum levels in adult dialysis patients. Am J Kidney Dis. 2005 Aug;46(2):316-9.
  • 22. National Kidney Foundation, Kidney Disease Outcomes Quality Initiative. Guideline 11: aluminum overload and toxicity in CKD. Guideline 12: treatment of aluminum toxicity. In: K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. New York, NY: National Kidney Foundation; 2003. Available at http://www.kidney.org/professionals/kdoqi/guidelines_bone/index.htm.
  • 23. Centers for Disease Control and Prevention (CDC). Elevated serum aluminum levels in hemodialysis patients associated with use of electric pumps--Wyoming, 2007. MMWR Morb Mortal Wkly Rep. 2008 Jun 27;57(25):689-91.
  • 24. Alexander S, Benfield M, Fine R. North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) 2002 Annual Report; 2002.
There are 24 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section Original Articles
Authors

Arzu Yazal Erdem 0000-0003-1043-8471

Nermin Uncu

Aysel Bulut This is me

Nilgün Çakar This is me

Publication Date December 3, 2019
Published in Issue Year 2019 Volume: 3 Issue: 3

Cite

APA Yazal Erdem, A., Uncu, N., Bulut, A., Çakar, N. (2019). Çocuk Diyaliz Hastalarında Anemi ve Aluminyum Düzeyleri. Ahi Evran Medical Journal, 3(3), 79-84.
AMA Yazal Erdem A, Uncu N, Bulut A, Çakar N. Çocuk Diyaliz Hastalarında Anemi ve Aluminyum Düzeyleri. Ahi Evran Med J. December 2019;3(3):79-84.
Chicago Yazal Erdem, Arzu, Nermin Uncu, Aysel Bulut, and Nilgün Çakar. “Çocuk Diyaliz Hastalarında Anemi Ve Aluminyum Düzeyleri”. Ahi Evran Medical Journal 3, no. 3 (December 2019): 79-84.
EndNote Yazal Erdem A, Uncu N, Bulut A, Çakar N (December 1, 2019) Çocuk Diyaliz Hastalarında Anemi ve Aluminyum Düzeyleri. Ahi Evran Medical Journal 3 3 79–84.
IEEE A. Yazal Erdem, N. Uncu, A. Bulut, and N. Çakar, “Çocuk Diyaliz Hastalarında Anemi ve Aluminyum Düzeyleri”, Ahi Evran Med J, vol. 3, no. 3, pp. 79–84, 2019.
ISNAD Yazal Erdem, Arzu et al. “Çocuk Diyaliz Hastalarında Anemi Ve Aluminyum Düzeyleri”. Ahi Evran Medical Journal 3/3 (December 2019), 79-84.
JAMA Yazal Erdem A, Uncu N, Bulut A, Çakar N. Çocuk Diyaliz Hastalarında Anemi ve Aluminyum Düzeyleri. Ahi Evran Med J. 2019;3:79–84.
MLA Yazal Erdem, Arzu et al. “Çocuk Diyaliz Hastalarında Anemi Ve Aluminyum Düzeyleri”. Ahi Evran Medical Journal, vol. 3, no. 3, 2019, pp. 79-84.
Vancouver Yazal Erdem A, Uncu N, Bulut A, Çakar N. Çocuk Diyaliz Hastalarında Anemi ve Aluminyum Düzeyleri. Ahi Evran Med J. 2019;3(3):79-84.

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