Despite recommendations for the use of iron therapy and erythropoiesis stimulating agents (ESA) to achieve optimal haemoglobin (Hb) levels, anaemia is a significant problem in children with Chronic Kidney Disease (CKD). Adverse effects of anaemia include left ventricular hypertrophy, impaired quality of life and cognitive function, and progression of CKD. Anaemia is also associated with reduced survival in dialysis patients.
The prevalence of anaemia in European children with established renal failure (ERF) is not known. This study was performed within the framework of the European Society of Paediatric Nephrology and the European Renal Association and European Dialysis and Transplant Association Registry to determine the prevalence of anaemia in European children with ERF, identify risk factors for anaemia, and determine adequacy of treatment.
Methods Data were collected from 2331 patients with ERF aged <18 years from 2000 to 2009, from 16 European countries, providing 5499 measurements. Percentages were weighted according to the number of Hb measurements.
Results Using European adult and UK National Institute of Clinical Excellence Anaemia guidelines, 44.5% of the patients were anaemic, and 8.5% had very low Hb levels. Only 32.6% of all patients were within the target range. Hb levels increased with increasing age and were higher in peritoneal dialysis (PD) compared with haemodialysis (HD) patients. Patients between the ages of 2 to 5 and 6 to 12 years had a 50% higher chance of being anaemic than adolescents. Patients on HD had a 1.5 times increased risk of being anaemic as compared to PD patients. In countries with information on ESA treatment, ESAs were prescribed in 75 to 100% of patients. Gender, age, dialysis modality and cause of renal failure were not were significantly associated with different use of ESAs.
Conclusion Despite increasing awareness of the deleterious long term effects of anaemia, anaemia is still a common problem in children on dialysis. In this study, nearly half of children were anaemic, despite virtually all patients being prescribed an ESA. Younger children and those on HD had a greater chance of being anaemic. European guidelines are needed to help optimise the management of anaemia in children on dialysis.