Presenter Status
Fellow
Abstract Type
Research
Primary Mentor
Judith Sebestyen VanSickle
Start Date
11-5-2021 11:30 AM
End Date
11-5-2021 1:30 PM
Presentation Type
Poster Presentation
Description
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.
Objectives/Goal: The primary aim of this study was to determine whether there is a significant association between ESA dose and blood pressure (BP) in pediatric patients on dialysis. The secondary aim was to determine covariates in relation to ESA dose.
Methods/Design: Data from the International Pediatric Dialysis Network (IPDN) database was used to retrospectively analyze 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 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. Chi-Square testing was used to analyze ESA dosing groups (<100units/kg/week, >250units/kg/week) with standardized systolic blood pressure (50th-90th percentile, >90th percentile).
Results: 3791 children were included in the analysis. Mean age was 11 years (± 5.87 SD) and 55.7% were male. The mean prescribed dose of ESA was 218 units/kg/week (± 982 SD). A significant association was found between ESA dose and standardized systolic blood pressure (X2= 27.91, p250 units/kg/week) were 1.71 (95% CI 1.3989-2.0829) times more likely to have hypertension (systolic BP >90th percentile) than those children who received a lower dose of ESA (/kg/week).
Conclusions: The preliminary results from this study suggest that there is an association between higher doses of ESAs and higher systolic BP in children receiving maintenance dialysis. Multivariate analysis to assess for the influence of covariates on this relationship is on-going.
MeSH Keywords
Pediatric; Dialysis; Hypertension
Additional Files
Association Between Blood Pressure and ESA Dose in Pediatric Pati.pdf (221 kB)Abstract
Included in
Higher Education and Teaching Commons, Medical Education Commons, Nephrology Commons, Pediatrics Commons, Science and Mathematics Education Commons
Association Between Blood Pressure and ESA Dose in Pediatric Patients on Dialysis
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.
Objectives/Goal: The primary aim of this study was to determine whether there is a significant association between ESA dose and blood pressure (BP) in pediatric patients on dialysis. The secondary aim was to determine covariates in relation to ESA dose.
Methods/Design: Data from the International Pediatric Dialysis Network (IPDN) database was used to retrospectively analyze 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 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. Chi-Square testing was used to analyze ESA dosing groups (<100units/kg/week, >250units/kg/week) with standardized systolic blood pressure (50th-90th percentile, >90th percentile).
Results: 3791 children were included in the analysis. Mean age was 11 years (± 5.87 SD) and 55.7% were male. The mean prescribed dose of ESA was 218 units/kg/week (± 982 SD). A significant association was found between ESA dose and standardized systolic blood pressure (X2= 27.91, p250 units/kg/week) were 1.71 (95% CI 1.3989-2.0829) times more likely to have hypertension (systolic BP >90th percentile) than those children who received a lower dose of ESA (/kg/week).
Conclusions: The preliminary results from this study suggest that there is an association between higher doses of ESAs and higher systolic BP in children receiving maintenance dialysis. Multivariate analysis to assess for the influence of covariates on this relationship is on-going.
