Evaluation Causes of Erythropoietin-stimulating agent Resistance in Chronic Kidney Disease Children at a Tertiary Hospital

Routine clinical and laboratory assessments facilitate diagnosis of erythropoietin (EPO) resistant anemia by allowing early identification of patients with nonadherence. Resistance to erythropoietin (EPO) rarely happen in Chronic Kidney Disease (CKD) children and can be affected by many factors such as poor compliance, hyperparathyroidism, malnutrition, inadequate dosages and medication. We studied the frequency and the cause of EPO resistant in CKD children.

This observational retrospective study was performed in 2008 in Aliasghar pediatric hospital. Children who were treated by EPO and had still Hemoglobin (Hb) less than 10mg/dl considered as resistant anemic cases. Therefore, their related data consisting of demographic data, EPO dosage, medications, underlying disease, the mode of dialysis and lab tests were reviewed.

among 20 cases reviewed, 8(40%) had Hb<8.male to female ratio was 1.66. The median range of age was 7.9 y/o. the median Hb was 6.25 mg/dl. 3 cases (37.5%) was true resistant in EPO agent (2 patient had bone marrow fibroses due to hyperparathyroidism and 1 had EPO Ab) and 5 cases (62.5%) had inadequate dosage of EPO (incompliance)

EPO unresponsiveness is frequent and because of its heterogeneous causes need full investigation including complete history to find the underlying reason.