Resistance to Epoetin-Stimulating Agents in Children Receiving Renal Replacement Therapy

The incidence of anemia increases with the stage of chronic kidney disease (CKD). Erythropoietin (EPO) deficiency is a common cause of anemia in CKD. Erythropoietin-stimulating agents (ESAs) are the mainstay of the treatment. Treatment can be challenging due to erythropoietin resistance (ER), which can be assessed using the erythropoietin resistance index (ERI). Our aim was to investigate the factors contributing to high ERI levels in children receiving renal replacement therapy (RRT). Thirty-three children receiving RRT for at least 3 months were included. The mean ERI value was 15.7 IU/kg/w/g/dL. A significant association was observed between serum phosphorus levels and ERI (P = .016, r = 0.41). The mean parathormone (PTH) level was also higher in the high ERI group (599 +/- 351 vs 392 +/- 320 pg/mL, P = .088). An association, approaching statistical significance, was found between ERI and hypertension (P = .06, r = 0.32). Our study indicated a potential relationship between hyperphosphatemia, possibly secondary hyperparathyroidism, and ERI in children undergoing RRT.