Chavers Blanche M, Roberts Tricia L, Herzog Charles A, Collins Allan J, St Peter Wendy L
Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota 55455, USA.
Kidney Int. 2004 Jan;65(1):266-73. doi: 10.1111/j.1523-1755.2004.00357.x.
Recent guidelines recommend a target hemoglobin range of 11 to 12 g/dL in pediatric and adult dialysis patients. We compared anemia prevalence in United States Medicare pediatric and adult dialysis patients.
Prevalent hemodialysis patients (0 to 19 years, pediatric: N= 1692; adult: N= 352,291) and peritoneal dialysis patients (pediatric: N= 597; adult: N= 39,136) treated with recombinant human erythropoietin (rHuEPO) from 1996 to 2000 were selected. Mean annual hemoglobin values were calculated by modality, age, sex, and race.
Among hemodialysis patients, mean annual hemoglobin values less than 11 g/dL were present in pediatric and adult patients during 54.1% versus 39.8% patient years, respectively (P < 0.0001); for peritoneal dialysis patients, 69.5% versus 55.1% (P < 0.0001). Mean hemoglobin values increased over time and were 11.2, 11.5, 10.8, and 11.2 g/dL for pediatric and adult hemodialysis and peritoneal dialysis patients, respectively, in 2000. Pediatric hemodialysis patients received intravenous iron less frequently than adults (66.3% vs. 82.5% patient years; P < 0.0001).
Hemoglobin values in rHuEPO-treated pediatric dialysis patients lagged behind those of adult patients, with pediatric patients achieving target hemoglobin values only a minority of the time (45.9% and 30.5% patient years, respectively, for hemodialysis and peritoneal dialysis). Trends show recent improvement in anemia treatment of children on dialysis. Still, further attention to and analysis of rHuEPO and iron therapy in pediatric dialysis patients is warranted.
近期指南建议儿科和成人透析患者的血红蛋白目标范围为11至12 g/dL。我们比较了美国医疗保险覆盖的儿科和成人透析患者的贫血患病率。
选取1996年至2000年接受重组人促红细胞生成素（rHuEPO）治疗的血液透析患者（0至19岁，儿科：N = 1692；成人：N = 352,291）和腹膜透析患者（儿科：N = 597；成人：N = 39,136）。按透析方式、年龄、性别和种族计算年均血红蛋白值。
在血液透析患者中，儿科和成人患者年均血红蛋白值低于11 g/dL的情况分别占患者年数的54.1%和39.8%（P < 0.0001）；对于腹膜透析患者，这一比例分别为69.5%和55.1%（P < 0.0001）。血红蛋白均值随时间增加，2000年儿科和成人血液透析及腹膜透析患者的血红蛋白均值分别为11.2、11.5、10.8和11.2 g/dL。儿科血液透析患者接受静脉铁剂治疗的频率低于成人（患者年数分别为66.3%和82.5%；P < 0.0001）。
接受rHuEPO治疗的儿科透析患者的血红蛋白值落后于成人患者，儿科患者仅在少数时间（血液透析和腹膜透析分别为患者年数的45.9%和30.5%）达到目标血红蛋白值。趋势显示近期透析儿童的贫血治疗有所改善。尽管如此，仍有必要进一步关注和分析儿科透析患者的rHuEPO和铁剂治疗。
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