Abstract
Children with chronic kidney disease (CKD) are at high risk of anemia, an important risk factor for cardiovascular disease and poor quality of life. The present study used baseline data from the Korean cohort study for Outcome in patients With Pediatric Chronic Kidney Disease (KNOW-PedCKD). A Total of 437 patients was included in the analyses excluding missing data. The characteristics of patients with and without anemia and those of patients with and without iron deficiency were compared. Logistic regression analysis and Pearson correlation were conducted to evaluate associated risk factors and correlations in children with CKD. Anemia in children with CKD was associated with older age, low body weight and body mass index (BMI) z-score, birth age, preceding glomerulonephritis, decreased estimated glomerular filtration rate (eGFR), low levels of serum albumin and calcium, high levels of serum intact parathyroid hormone (iPTH), and serum phosphorus. Anemia was correlated positively with changes in the BMI z-score, body weight, and serum albumin and cholesterol levels, but correlated negatively with serum calcium, iPTH, ferritin levels, and transferrin saturation. Iron deficiency in children with CKD was associated with young age, low hemoglobin and serum ferritin levels, high BMI z-scores, and low levels of serum iPTH. This is the first nationwide cohort study of anemia in Korean children with CKD and the first prospective pediatric CKD cohort study in Asia. The study results demonstrated that anemia and iron deficiency are affected by various factors, including age, BMI, and levels of serum iPTH. To improve the retrospective outcome of affected children, it is important to understand the effect of each of these factors and to attempt an early intervention to prevent anemia and iron deficiency by regular measurement of these parameters in children at risk.
Highlights
Anemia is a major complication in children with chronic kidney disease (CKD)
The multiple logistic regression analysis demonstrated that an increased body mass index (BMI) z-score and decreased intact parathyroid hormone (iPTH), hemoglobin, and ferritin levels were risk factors associated with iron deficiency in children with CKD (Table 9)
This article is noteworthy because it is the first multicenter cohort study investigating the impact of anemia in Korean pediatric patients with CKD and the first prospective pediatric CKD cohort study in Asia
Summary
Anemia is a major complication in children with chronic kidney disease (CKD). Among children with CKD, anemia is an important risk factor for the development and progression of cardiovascular disease, including left ventricular hypertrophy [2,3]. The chronic inflammatory state in patients with CKD results in decreased erythropoiesis in the bone marrow, reduced production of erythropoietin (EPO) in the kidneys, and impaired iron absorption and mobilization due to increased production of hepcidin in the liver. Oxidative stress, and nutritional deficiencies contribute to anemia in CKD [6]. Treatment of anemia in children with CKD is known to be less effective than that in adults [9], and studies of anemia and iron deficiency are limited due to the small numbers of pediatric patients with CKD
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