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Background: Hypertension is a reported side effect of Erythropoiesis Stimulating Agents (ESAs), with a mechanism of action related to elevated hematocrit levels and direct vasopressor effects. Limited information exists on the relationship between ESA dosage and hypertension in children receiving maintenance dialysis.

Objective: The primary aim of this study was to determine whether there is a significant correlation between ESA dose and blood pressure (BP) in pediatric patients on dialysis. The secondary aim was to determine confounding variables in relation to ESA dose and BP.

Design/Methods: Data from the International Pediatric Dialysis Network (IPDN) database was used to retrospectively evaluate the association between ESA dose and BP. Data collected from January 2007 to September 2019 was analyzed. Systolic and diastolic BP measurements obtained at clinic visits were averaged and standardized based on age, height, and sex. ESA dose was measured in units/kg/week with Darbepoetin and continuous erythropoietin receptor activator (CERA) converted to equivalent units of Epogen. The confounding variables analyzed include hemoglobin level, BMI, dialysis modality, total fluid output (daily ultrafiltrate plus 24-hour urine output), number of antihypertensive medications, and use of growth hormone. Linear regression with Pearson correlation was used to analyze continuous variables.

Results: A total of 3790 children were included in the analysis with a mean age of 11 years and 55.7% male. The mean prescribed dose of ESA was 192 units/kg/week. A significant positive correlation was noted between ESA dose and systolic BP (p < 0.001) although there was no significant correlation with diastolic BP (p=0.2). Further evaluation showed a significant negative correlation between ESA dose, total fluid output, and hemoglobin level in univariate and multivariate analysis, p < 0.001.

Conclusion(s): The preliminary results from this study suggest that there may be a correlation between higher doses of ESAs and higher systolic BP in children receiving maintenance dialysis. Ongoing analysis of confounding variables will be helpful in determining the full correlation between ESA dose and BP.

Presented at the 2021 PAS Virtual Conference


Nephrology | Pediatrics

Association Between ESA Dose and Blood Pressure in Pediatric Patients on Dialysis