TY - JOUR
T1 - Secondary Hyperparathyroidism and Anemia in Children Treated by Hemodialysis
AU - Smith, Lorie B.
AU - Fadrowski, Jeffrey J.
AU - Howe, Chanelle J.
AU - Fivush, Barbara A.
AU - Neu, Alicia M.
AU - Furth, Susan L.
N1 - Funding Information:
Support: Dr Smith is supported by National Institutes of Health (NIH) grant 5T32DK007732 , a Ruth L. Kirschstein National Research Service Award, and a Renal Disease Epidemiology Training Grant. Dr Fadrowski is supported by NIH/National Institute of Environmental Health Sciences grant K23ES016514 , and a National Kidney Foundation Young Investigator Grant. Dr Howe is supported by NIH/National Institute on Drug Abuse grant 5F31DA022114-02 and a Ruth L. Kirschstein National Research Award Predoctoral Fellowship. Dr Fivush is supported by NIH grant U01DK074082 . Dr Neu is supported by a NephCure Foundation Grant, a grant for Protocol 20050256 from Amgen Inc, and an Investigator-Initiated Grant from Merck & Co Inc. Dr Furth is supported by NIH/NIDDK (National Institutes of Diabetes and Digestive and Kidney Diseases ) grant K24DR078737-01 , NIH/NIDDK grant UL1 RR025005 , NIH/NIDDK U01 DK066174 , Montefiore Medical Center Prime Grant U01 DK63549 , and a grant for Protocol #85-036 from Genetech .
PY - 2010/2
Y1 - 2010/2
N2 - Background: Many patients treated using hemodialysis remain anemic despite exogenous erythropoietin therapy, suggesting that the anemia experienced by these patients is multifactorial in cause. Iron deficiency, infection, inflammation, and malnutrition have been implicated in this process. Additionally, secondary hyperparathyroidism has been associated with anemia in adults, but few data exist about this topic in children. Study Design: Cross-sectional retrospective. Setting & Participants: Children treated in hemodialysis centers (N = 588) within the Centers for Medicare & Medicaid Services' 2002 Clinical Performance Measures Project. Predictor: Intact parathyroid hormone (iPTH) levels assessed in October, November, and December 2001 and categorized as quintiles. Outcomes & Measurements: Achievement of serum hemoglobin level ≥ 11 g/dL was assessed using Poisson regression adjusting for sex, age, race, dialysis vintage, vascular access type, single-pool Kt/V, serum albumin level, normalized protein catabolic rate, calcium-phosphorus product, and erythropoietin alfa dose. Results: Using the second quintile (iPTH, 103-224 pg/mL) as the reference quintile, there was no association between iPTH quintile and achievement of the hemoglobin goal: quintile 1 prevalence ratio, 1.0 (95% CI, 0.9-1.2); quintile 3, 0.95 (95% CI, 0.8-1.1); quintile 4, 0.99 (95% CI, 0.8-1.2); and quintile 5, 0.97 (95% CI, 0.8-1.1). Only serum albumin level ≥ 3.5 g/dL (bromocresol green assay method) or ≥ 3.2 g/dL (bromocresol purple assay method) was significantly associated with meeting the hemoglobin goal: 1.4 (95% CI, 1.2-1.6). Limitations: The simultaneous collection of iPTH and hemoglobin limits causal inference. Iron stores and iron therapy are potential confounders not accounted for in this study. Conclusions: In the largest study of this topic in children, no association was found between iPTH level and achievement of a hemoglobin level ≥ 11 g/dL. Serum albumin level was associated strongly with achievement of the hemoglobin goal.
AB - Background: Many patients treated using hemodialysis remain anemic despite exogenous erythropoietin therapy, suggesting that the anemia experienced by these patients is multifactorial in cause. Iron deficiency, infection, inflammation, and malnutrition have been implicated in this process. Additionally, secondary hyperparathyroidism has been associated with anemia in adults, but few data exist about this topic in children. Study Design: Cross-sectional retrospective. Setting & Participants: Children treated in hemodialysis centers (N = 588) within the Centers for Medicare & Medicaid Services' 2002 Clinical Performance Measures Project. Predictor: Intact parathyroid hormone (iPTH) levels assessed in October, November, and December 2001 and categorized as quintiles. Outcomes & Measurements: Achievement of serum hemoglobin level ≥ 11 g/dL was assessed using Poisson regression adjusting for sex, age, race, dialysis vintage, vascular access type, single-pool Kt/V, serum albumin level, normalized protein catabolic rate, calcium-phosphorus product, and erythropoietin alfa dose. Results: Using the second quintile (iPTH, 103-224 pg/mL) as the reference quintile, there was no association between iPTH quintile and achievement of the hemoglobin goal: quintile 1 prevalence ratio, 1.0 (95% CI, 0.9-1.2); quintile 3, 0.95 (95% CI, 0.8-1.1); quintile 4, 0.99 (95% CI, 0.8-1.2); and quintile 5, 0.97 (95% CI, 0.8-1.1). Only serum albumin level ≥ 3.5 g/dL (bromocresol green assay method) or ≥ 3.2 g/dL (bromocresol purple assay method) was significantly associated with meeting the hemoglobin goal: 1.4 (95% CI, 1.2-1.6). Limitations: The simultaneous collection of iPTH and hemoglobin limits causal inference. Iron stores and iron therapy are potential confounders not accounted for in this study. Conclusions: In the largest study of this topic in children, no association was found between iPTH level and achievement of a hemoglobin level ≥ 11 g/dL. Serum albumin level was associated strongly with achievement of the hemoglobin goal.
KW - Secondary hyperparathyroidism
KW - anemia
KW - hemodialysis
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U2 - 10.1053/j.ajkd.2009.09.033
DO - 10.1053/j.ajkd.2009.09.033
M3 - Article
C2 - 20116689
AN - SCOPUS:74549169907
SN - 0272-6386
VL - 55
SP - 326
EP - 334
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 2
ER -