ESPN 53rd Annual Meeting

ESPN 2021


 
Attainment of KDIGO 2012 clinical practice guideline targets for anaemia management in children with Pre-dialysis CKD, a single centre study
HARRIET GASS 1 CAROLINE BOOTH 1 JO CLOTHIER 1 PERNILLE RASMUSSEN 1 NABIL MELHEM 1

1- EVELINA LONDON CHILDREN’S HOSPITAL
 
Introduction:

Anaemia is an independent risk factor for hospitalisation and cardiovascular disease in children with CKD. We report on the attainment of KDIGO (Kidney Disease: Improving Global Outcomes) guideline targets for the management of anaemia in the paediatric pre-dialysis CKD population. 

Material and methods:

Single centre, retrospective cross-sectional study including all prevalent children aged 0-18 years with pre-dialysis advanced CKD in a dedicated clinic. Anaemia was defined as per the KDIGO 2012 clinical practice guideline for anaemia management in patients with chronic kidney disease. Modifiable and non-modifiable covariates were analysed for their associations with anaemia in this group. 

Results:

137 children were included with a mean age of 9.2 ± 5.1 years and a mean eGFR of 32.6 ± 21.1 ml/min/1.73m2. 4%, 47%, 37% and 12% had stages of CKD 2, 3, 4 and 5 respectively. 90 (65.6%) were boys, and 103 (75.1%) had congenital abnormalities of kidneys and urinary tract (CAKUT). Mean length of time in the dedicated CKD clinic was 5.3 ± 4.4 years. 

 

46 (33.6%) were classified as anaemic, of which 31 (67.4%) were on iron supplementation and/or erythropoiesis-stimulating agent (ESA) treatment. 46 (33.6%) maintained target haemoglobin levels with iron supplementation and/or ESA treatment and 45 (32.8%) maintained target haemoglobin levels with no treatment. Non-CAKUT primary kidney disease (PKD), lower eGFR and higher parathyroid hormone (PTH) were identified as covariates significantly associated with anaemia in this population (p<0.05). 

Conclusions:

In a population of children with advanced CKD, we have shown that whilst the majority achieved target hemoglobin levels, a significant proportion were anaemic despite most receiving iron and/or ESA therapy. Non-CAKUT PKD, lower eGFR and higher PTH were associated with anaemia, and these factors should warrant further attention from clinicians. Strategies are needed to identify and overcome barriers to achieving target haemoglobin levels in children with CKD.