Role of erythropoietin in anemic children with chronic renal failure in Diyala Governorate, Iraq
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Abstract
Background: Chronic conditions, such as anemia are often attributed to insufficient production of erythropoietin. This study focuses on evaluating the effectiveness and safety of recombinant erythropoietin therapy in managing anemia associated with chronic kidney disease.
Methods: A prospective cross-sectional study was conducted on 40 patients diagnosed with anemia due to chronic kidney disease. The study took place from August 1, 2022, to February 30, 2023, at Al-Batool Teaching Hospital in Diyala Province, Iraq. The participants were divided into two groups: the first group comprised 30 patients aged between 80 days and 15 years receiving conservative treatment, while the second group included 10 patients aged 6 to 13 years undergoing hemodialysis. Data analysis, including descriptive and bivariate methods, was performed using SPSS Version 20, with a p-value of less than 0.05 considered statistically significant.
Results: In this study, group I patients had a mean age of 7.1 years, with two-thirds (66.6%) falling within the 1–10 age range and a male-to-female ratio of 1.7:1. In group II, the mean age was 9.5 years, with 60% in the 5–10 age group and a balanced gender ratio (1:1). The primary causes of chronic renal failure (CRF) in Group I were cystinosis and reflux nephropathy (26.7% each), while laboratory findings revealed a mean glomerular filtration rate (GFR) of 72.19 mL/min and severe anemia with hemoglobin (Hb) levels of 4.7 g/dL before treatment. Treatment significantly improved Hb levels in Group I (7.47 to 10.17 g/dL, P < 0.001) but showed limited efficacy in Group II (6.9 to 8.2 g/dL, P = 0.002).
Conclusion: The findings underscore variable treatment responses between groups, emphasizing the need for tailored anemia management strategies.
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Vadakedath S, Kandi V. Dialysis: A review of the mechanisms underlying complications in the management of chronic renal failure. Cureus. 2017; Available from: http://dx.doi.org/10.7759/cureus.1603
El-Shafei AM, El-Mashad GM, Azzam AA. Oxidative stress markers in children with end-stage kidney disease. J Clin Pediatr Nephrol. 2014;2(2):25. Available from: http://dx.doi.org/10.15401/jcpn/2014/v2i2/66344
Brundha MP, Pathmashri VP, Sundari S. Quantitative changes of red blood cells in cancer patients under palliative radiotherapy: A retrospective study. Res J Pharm Technol. 2019;12(2):687. Available from: http://dx.doi.org/10.5958/0974-360x.2019.00122.7
Hasegawa T, Bragg-Gresham JL, Pisoni RL, Robinson BM, Fukuhara S, Akiba T, et al. Changes in anemia management and hemoglobin levels following revision of a bundling policy to incorporate recombinant human erythropoietin. Kidney Int. 2011;79(3):340–6. Available from: http://dx.doi.org/10.1038/ki.2010.382
Sanyaolu A, Okorie C, Annan R, Turkey H, Akhtar N, Gray F, et al. Epidemiology and management of chronic renal failure: A global public health problem. Biostatistics Epidemiol Int J. 2018;1(1):11–6.
Guzzo I, Atkinson MA. Anemia in chronic kidney disease. In: Pediatric Nephrology. Cham: Springer International Publishing; 2022. p. 1779–94.
Agarwal N, Khatri N, Singh P. Pancytopenia in pregnant patients with COVID-19 infection and vitamin B12 deficiency: A case report study. J Ideas Health. 2021 Jul 21;4(Special2):415–8. doi: 10.47108/jidhealth.Vol4.IssSpecial2.138
Fertrin KY. Diagnosis and management of iron deficiency in chronic inflammatory conditions (CIC): Is too little iron making your patient sick? Hematology Am Soc Hematol Educ Program. 2020 ;2020(1):478–86. Available from: http://dx.doi.org/10.1182/hematology.2020000132
Ali Jadoo SA, Salman RE, Ali AY, Haider AI. Factors influencing hemoglobin levels in pregnant women: A cross-sectional study in Iraq. J Lifelong DentoMed Health. 2024;1(1):01–6. Available from: https://jldmhealth.com/Jldmh/article/view/1
Fishbane S, Spinowitz B. Update on anemia in ESRD and earlier stages of CKD: Core curriculum 2018. Am J Kidney Dis. 2018;71(3):423–35. Available from: http://dx.doi.org/10.1053/j.ajkd.2017.09.026
Bazargani B, Mojtahedi SY, Fahimi D, Askarian F, Moghtaderi M, Abbasi A, et al. Evaluation of the relationship between serum carnitine levels and intradialytic complications in children with kidney failure. Pediatr Nephrol. 2022 ;37(9):2179–83. Available from: http://dx.doi.org/10.1007/s00467-022-05449-w
Heidari R, Jafari F, Khodaei F, Shirazi Yeganeh B, Niknahad H. Mechanism of valproic acid-induced Fanconi syndrome involves mitochondrial dysfunction and oxidative stress in rat kidney. Nephrology (Carlton). 2018;23(4):351–61. Available from: http://dx.doi.org/10.1111/nep.13012
Faught LN, Greff MJE, Rieder MJ, Koren G. Drug-induced acute kidney injury in children. Br J Clin Pharmacol. 2015;80(4):901–9. Available from: http://dx.doi.org/10.1111/bcp.12554
Lullo D, Di Lullo L, Magnocavallo MD, Vetta M, Lavalle G, Barbera C, et al. Atrial fibrillation, oral anticoagulation and nephroprotection: Caution or bravery? G Ital Nefrol. 2022.
Gosik R, Danel K. The rising risk of chronic kidney disease (CKD) and how it is dealt with: A review of current and potential phosphate binders (PB). Mini Rev Med Chem. 202;21(19):3052–61. Available from: http://dx.doi.org/10.2174/1389557521666210616161728
Ralley FE. Erythropoietin and intravenous iron in PBM. Transfus Apher Sci. 2014;50(1):16–9. Available from: http://dx.doi.org/10.1016/j.transci.2013.12.007
Kalra PA, Bhandari S. Safety of intravenous iron use in chronic kidney disease. Curr Opin Nephrol Hypertens [Internet]. 2016;25(6):529–35. Available from: http://dx.doi.org/10.1097/MNH.0000000000000263
Behera V, Chauhan R, Sinha S, Nair V. Anaphylactic shock secondary to intravenous iron sucrose in chronic kidney disease. Indian J Hematol Blood Transfus. 2015;31(3):391–3. Available from: http://dx.doi.org/10.1007/s12288-014-0475-0
Chen TK, Knicely DH, Grams ME. Chronic kidney disease diagnosis and management: a review. JAMA. 2019 Oct 1;322(13):1294–304. doi: 10.1001/jama.2019.14745
Harris RC, Zhang MZ. The role of gender disparities in kidney injury. Ann Transl Med. 2020 Apr;8(7):514. doi: 10.21037/atm.2020.01.23
Ahmed NF, Hussain H. Chronic renal failure in children admitted to Children Welfare Teaching Hospital. Iraqi Postgrad Med J. 2008;7:12–7.
Akhtar N, Tahir M, Kiran S. Recombinant human erythropoietin therapy in predialysis patients of chronic kidney diseases. Home. 2010;2(1):180–5.
Hain D, Bednarski D, Cahill M, Dix A, Foote B, Haras MS, et al. Iron-deficiency anemia in CKD: a narrative review for the kidney care team. Kidney Med. 2023 May 25;5(8):100677. doi: 10.1016/j.xkme.2023.100677
Loro MP, Ramírez DS, Álvarez FO, Rodríguez FS. Congenital anomalies of the kidney and urinary tract. A vision for the paediatrician. An Pediatr (Engl Ed). 2015;83(6):442-e443.
Klaus R, Lange-Sperandio B. Chronic kidney disease in boys with posterior urethral valves-pathogenesis, prognosis, and management. Biomedicines. 2022;10(8):1894. Available from: http://dx.doi.org/10.3390/biomedicines10081894
Alezzi JI, Taghlub HA, Yahia A, Al-ezzi BNA, Ali Jadoo SA. Impact of maternal age on congenital heart disease among children in Diyala Province, Iraq. J Lifelong DentoMed Health. 2024;1(1):22–6. Available from: https://jldmhealth.com/Jldmh/article/view/6
Badura K, Janc J, Wąsik J, Gnitecki S, Skwira S, Młynarska E, et al. Anemia of chronic kidney disease—a narrative review of its pathophysiology, diagnosis, and management. Biomedicines. 2024;12(6):1191. doi: 10.3390/biomedicines12061191
Tartarone A, Lerose R, Tartarone M. Erythropoiesis-stimulating agents in the treatment of chemotherapy-induced anemia: what do guidelines say? AME Med J. 2023;8:32. doi: 10.21037/amj-23-79
Chung EY, Palmer SC, Saglimbene VM, Craig JC, Tonelli M, Strippoli GF. Erythropoiesis-stimulating agents for anemia in adults with chronic kidney disease: a network meta-analysis. Cochrane Database Syst Rev. 2023 Feb 13;2(2):CD010590. doi: 10.1002/14651858.CD010590.pub3
Chen N, Hao C, Peng X, Lin H, Yin A, Hao L, et al. Roxadustat for anemia in patients with kidney disease not receiving dialysis. N Engl J Med. 2019 Sep 12;381(11):1001–10. doi: 10.1056/NEJMoa1813599
Fishbane S, Ford M, Fukagawa M, McCafferty K, Rastogi A, Spinowitz B, et al. Randomized, double-blind, placebo-controlled study of sodium zirconium cyclosilicate for reducing the incidence of predialysis hyperkalemia. J Am Soc Nephrol. 2019 Sep;30(9):1723–33. doi: 10.1681/ASN.2019050450
Ali Jadoo SA, Alhusseiny AH, Yaseen SM, Al-Samarrai MAM, Mahmood AS. Evaluation of health system in Iraq from people’s point of view: a comparative study of two different eras. J Ideas Health. 2021 May 20;4(2):380-8. doi: 10.47108/jidhealth.vol4.iss2.100