Evaluation of clinical and laboratory variables associated with anemia in
               pediatric patients on hemodialysis

Freitas, Johnathan S. de; Costa, Paulo Sucasas; Costa, Luciane Rezende; Naghettini, Alessandra V.

doi:10.1016/j.jped.2014.05.009

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Original Articles • J. Pediatr. (Rio J.) 91 (1) • Jan-Feb 2015 • https://doi.org/10.1016/j.jped.2014.05.009 copy

Evaluation of clinical and laboratory variables associated with anemia in pediatric patients on hemodialysis^☆ ☆ Please cite this article as: de Freitas JS, Costa PS, Costa LR, Naghettini AV. Evaluation of clinical and laboratory variables associated with anemia in pediatric patients on hemodialysis. J Pediatr (Rio J). 2015;91:87-92. ^☆☆ ☆☆ Study conducted at Post-Graduation program in Health Sciences, Universidade Federal de Goiás (UFG), Goiânia, GO, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE:

To identify the occurrence of anemia in pediatric patients on hemodialysis and the association between hemoglobin levels and anemia in CKD-related variables.

METHODS:

This was a retrospective study. Patients aged up to 18 years with chronic kidney disease undergoing hemodialysis at this service between January of 2009 and December of 2010 were selected. Clinical and laboratory data were obtained from medical records. Statistical analysis was performed with chi-squared test, Student's t-test and general estimating equations (GEE) using SPSS 20.0, assuming a significance level of 5%.

RESULTS:

A total of 357 medical records depicting the monthly evolution of 29 patients were analyzed. The most common etiology for chronic kidney disease was malformations of the genitourinary tract (28%). Hemoglobin showed a mean (standard deviation) value of 9.20 (1.8) g/dL, with the occurrence of anemia in 65.3% of cases. Anemia was associated with hospitalization; antibiotic use; transfusion; use of intravenous iron hydroxide; low values of creatinine, hematocrit, and albumin; and high values of ferritin, aluminum, and equilibrated Kt/V (p < 0.05). The odds ratio for anemia with the use of intravenous iron hydroxide was 0.36 (95% CI: 0.25 to 0.89), i.e., a 2.78-fold higher chance of developing anemia without the use of this medication.

CONCLUSIONS:

Anemia predominated in children and adolescents with chronic kidney disease; intravenous iron hydroxide use was a protective factor.

Anemia; Adolescent; Child; Kidney dialysis; Renal failure

Independent variables	n	Total sample	Anemia		p
			Yes (n = 233)	No (n = 124)
Medical history, n (%)
Need for hospitalization	316	52 (14.6%)	43 (20.7%)	9 (8.3%)	0.005^a
Antibiotic use	316	60 (16.8%)	48 (23.1%)	12 (11.1%)	0.010^a
Need for transfusion	316	11 (3.1%)	56 (26.9%)	3 (2.8%)	< 0.001^a
Double-lumen catheter infection	316	59 (16.5%)	10 (4.8%)	1 (0.9%)	0.105^a

Main medications used in the treatment of anemia, n (%)
Folic acid	339	333 (93.3%)	222 (98.7%)	111 (97.4%)	0.392^a
Vitamin B complex	339	332 (93.0%)	221 (98.2%)	111 (97.4%)	0.601^a
Vitamin C	339	327 (91.6%)	219 (97.3%)	108 (94.7%)	0.222^a
Erythropoietin	321	303 (84.9%)	201 (94.4%)	102 (94.4%)	0.977^a
Intravenous iron hydroxide	318	160 (44.8%)	89 (42.4%)	71 (65.7%)	< 0.001^a

Laboratory exams, mean (standard deviation)
Pre-hemodialysis session urea (mg/dL)	353	140.5 (42.3)	143.2 (42.9)	135.5 (40.8)	0.104^b
Creatinine (mg/dL)	352	6.2 (2.1)	5.9 (2.1)	6.6 (2.1)	0.002^b
Hematocrit (%)	356	28.3 (5.7)	25.1 (4.0)	34.3 (3.0)	< 0.001^b
Power of hydrogen (pH) (AV)	119	7.4 (0.6)	7.4 (0.1)	7.4 (0.1)	0.177^b
Bicarbonate (mmol/L)	120	20.2 (3.8)	19.8 (3.4)	20.7 (4.1)	0.197^b
Ferritin (ng/L)	351	709.3 (460.0)	754.0 (479.1)	625.1 (413.1)	0.012^b
Transferrin saturation index (TSI) (%)	357	35.5 (19.4)	36.0 (20.2)	34.5 (17.9)	0.474^b
Iron (uG/dL)	340	75.7 (93.5)	74.7 (95.9)	78.0 (89.8)	0.754^b
Parathormone (PTH) (pg/mL)	347	520.3 (495.1)	526.2 (519.4)	513.2 (450.7)	0.815^b
Albumin (g/dL)	343	3.9 (0.5)	3.8 (0.6)	4.1 (0.2)	< 0.001^b
Aluminum (ug/dL)	167	24.1 (28.6)	28.0 (30.8)	16.0 (21.6)	0.011^b
Equilibrated Kt/V (eKt/V) (AV)	294	1.9 (0.4)	2.0 (0.4)	1.8 (0.4)	0.004^b

Independent variables	Odds ratio	95% Confidence interval		p value
		Minimum	Maximum
Need for hospitalization	1.00	0.52	1.93	0.988
Antibiotic use	1.97	0.89	4.35	0.095
Double-lumen catheter infection	4.13	0.49	34.60	0.191
Use of intravenous iron hydroxide	0.36	0.25	0.89	< 0.001

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E-mail: jped@jped.com.br

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[1] * Corresponding author. E-mail: sanfet2010@hotmail.com (J.S. de Freitas).