Libudzic-Nowak Anna Maria, Cachat Francois, Pascual Manuel, Chehade Hassib
Pediatric Nephrology Unit, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
Transplantation Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
Front Pediatr. 2018 Dec 18;6:398. doi: 10.3389/fped.2018.00398. eCollection 2018.
Anemia treatment in infants with advanced or chronic kidney disease (CKD) represents an important challenge to nephrologists. The use of darbepoetin alfa, a novel erythropoiesis stimulating agent, has largely replaced recombinant human erythropoietin in older children and in adults with CKD. However, studies reporting the use of darbepoetin alfa in infants below 1 year of age are rare. We report the data of three infants with advanced stage kidney failure, aged 1, 4, and 7 months, who were treated with darbepoetin alfa and followed for 18-41 months. Hemoglobin levels increased in all three patients, reaching the target levels of 10.7-12 g/dl by 11, 19, and 22 weeks respectively, without any documented adverse effects. Patients younger than 1 year of age required a larger darbepoetin alfa dosage (ranged from 1.2 to 2.9 μg/kg per month) as compared to older children. A review of the literature found only three studies using darbepoetin alfa successfully in such young infants, with similar dosage and clinical success. In these three patients with advanced kidney disease, darbepoetin alfa was effective in correcting anemia with no observed side effects. It reinforces its potential use in very young patients with advanced CKD.
对患有晚期或慢性肾病（CKD）的婴儿进行贫血治疗，是肾脏病学家面临的一项重大挑战。新型促红细胞生成刺激剂——阿法达贝泊汀，在年龄较大的儿童和成年CKD患者中已在很大程度上取代了重组人促红细胞生成素。然而，关于在1岁以下婴儿中使用阿法达贝泊汀的研究却很罕见。我们报告了3例晚期肾衰竭婴儿的数据，年龄分别为1个月、4个月和7个月，他们接受了阿法达贝泊汀治疗，并随访了18 - 41个月。所有3例患者的血红蛋白水平均有所升高，分别在11周、19周和22周时达到了10.7 - 12 g/dl的目标水平，且未记录到任何不良反应。与年龄较大的儿童相比，1岁以下的患者需要更大剂量的阿法达贝泊汀（每月剂量范围为1.2至2.9 μg/kg）。文献综述发现，仅有3项研究在如此年幼的婴儿中成功使用了阿法达贝泊汀，剂量和临床疗效相似。在这3例晚期肾病患者中，阿法达贝泊汀有效地纠正了贫血，且未观察到副作用。这进一步证明了其在患有晚期CKD的极年幼患者中的潜在应用价值。
