Kinetics, Dialysis Systems, and Adequacy Copper deficiency: A common cause of erythropoietin (rHuEPO) resistant anemia in children on hemodialysis (HD)?

• DOI: 10.1111/j.1492-7535.2005.1121ca.x
• Publication Date: 2005-01-12T13:28:59Z
• Authors: B.A. Warady; C. Nelms; J. Jennings; S. Johnson
• Keywords: 03 medical and health sciences; 0302 clinical medicine; 3. Good health

Copper (CU) deficiency, as reflected by a low serum CU and ceruloplasmin (CER) level, is rare complication of chronic HD. When present, common clinical manifestations include anemia neutropenia. Anecdotally, deficiency has been linked to the use sevelamer hydrochloride (SH), recently introduced phosphate binding agent. The finding severe rHuEPO‐resistant in 3 our patients (pts) prompted review entire pediatric HD population for frequency its possible relationship SH. An assessment was conducted 17 pts (male‐11; mean age 169.4 + 49.6 mo) who had received 21.5 33.9 months. All three 4‐hour sessions weekly with single‐pool equilibrated Kt/V values 2.29 2.5 1.56 0.37, respectively. 14 (82%) levels value 69.1 38.3 mcG/DL (normal = 85–150 mcG/DL). 9 (53%) <60 <25 CER 1.2 mg/dL, 0.6 1.8 respectively 24–40 mg/dL). In latter pts, hemoglobin fell 5.4 gm/dL, 5.2 9.2 gm/dL despite regular rHuEPO dosing adequate iron stores all responded supplemental therapy. remaining 11.7 1.3 gm/dL. Whereas 13 (93%) deficient were receiving SH (142.1 112.3 mg/kg/d) 331.0 293.6 days at time assessment, there no significant demonstrated between dose or duration therapy level. conclusion, appears commonly occur extremely associated profound responsive While chronology introduction suggests an association, additional research necessary address this issue more definitive manner.