BACKGROUND While adult hemodialysis (HD) patients have increased morbidity with higher target hemoglobin levels, similar findings have not been demonstrated in pediatric patients. We evaluated changes in transfusions, anemia frequency, and erythropoietin (epo) dosing among pediatric HD patients before, during, and after implementation of federal dialysis payment policies regarding epo dosing for adult HD patients. METHODS This is a retrospective cohort study of pediatric HD patients enrolled in NAPRTCS. We evaluated need for transfusion, anemia, median hemoglobin, and median epo dose 6 months after starting HD in 3 eras: baseline (2003-2007), implementation (2008-2011), and post implementation (2012-2016). We used multivariate logistic regression models to evaluate potential differences in transfusion across the eras. RESULTS Six months after dialysis initiation, 12.6% of patients required transfusion pre-implementation, 17.9% during implementation, and 15.5% post implementation. Anemia occurred in 17.4% of patients pre, 23.5% during, and 23.8% post implementation, with median hemoglobin levels of 11.9 g/dL pre, 11 g/dL during, and 11 g/dL post implementation. Epo use was high across all 3 eras, but epo dosing decreased during and post implementation, despite more anemia during these periods. Odds of transfusion in implementation era compared with pre-implementation was 1.75 (95% CI 1.11-2.77) and odds of transfusion in post implementation era compared with pre was 1.19 (95% CI 0.71-1.98), controlling for age, race, gender, and prior transplant status. CONCLUSIONS During and following implementation of adult epo dosing guidelines, transfusion and anemia frequency increased in pediatric HD patients. Ideal target hemoglobin levels for pediatric dialysis patients warrant further study.

中文翻译：

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成人促红细胞生成素剂量指南的变化对儿童促红细胞生成素剂量的使用，贫血和输血对血液透析的影响：北美小儿肾脏试验和协作研究（NAPRTCS）的发现。

背景技术虽然成人血液透析（HD）患者的发病率增加，目标血红蛋白水平更高，但在儿科患者中尚未证明类似的发现。我们评估了在针对成人HD患者进行epo剂量的联邦透析付款政策实施之前，期间和之后，小儿HD患者的输血，贫血频率和促红细胞生成素（epo）剂量的变化。方法这是一项针对NAPRTCS入组的小儿HD患者的回顾性队列研究。我们评估了3个时代开始HD后6个月的输血，贫血，中位血红蛋白和中位epo剂量的需要：三个时期：基线（2003-2007年），实施（2008-2011年）和实施后（2012-2016年）。我们使用多元logistic回归模型来评估各个时代在输血方面的潜在差异。结果透析开始后六个月，有12.6％的患者需要在实施前进行输血，在实施过程中需要17.9％，在实施后需要15.5％。贫血发生在实施前的17.4％，实施期间的23.5％和23.8％，中位数血红蛋白水平分别为实施前11.9 g / dL，实施期间11 g / dL和11 g / dL。在所有三个时代中，Epo的使用率都很高，但在这期间和之后实施epo的剂量有所减少，尽管在这期间贫血程度更高。与实施前相比，实施时期输血的几率是1.75（95％CI 1.11-2.77），在实施后时期与前相比输血的几率是1.19（95％CI 0.71-1.98），其中包括年龄，种族，性别，以及先前的移植状态。结论在实施成人epo剂量指南期间和之后，小儿HD患者的输血和贫血频率增加。小儿透析患者理想的目标血红蛋白水平值得进一步研究。