Recombinant human erythropoietin therapy in pediatric patients receiving long-term peritoneal dialysis

We evaluated the impact of (s.c.) recombinant human erythropoietin (r-HuEPO) therapy on the hematological status, exercise capacity, and dietary intake of nine pediatric patients (mean age 12.4±3.2 years) receiving long-term peritoneal dialysis. Five children without medical illness served as controls for the exercise testing portion of the study. Following 7.9±2.8 weeks of twice weekly r-HuEPO (50 units/kg per dose), the hematocrit increased from 21.9±3.5% to 31.3±2.5% (P<0.001). A further increase to 33.2±3.0% occurred after 2 months of once weekly therapy. The blood transfusion requirement decreased from 0.5 transfusions per patient-month to 0.05 transfusions per patient-month (P<0.01). Graded exercise testing demonstrated an increase in peak oxygen consumption from 17.8±5.2 to 24.0±7.6 ml/kg per min (P<0.01). The oxygen consumption at anaerobic threshold increased from 13.1±3.9 to 17.1±3.5 ml/kg per min (P<0.02). Treadmill time increased from 5.3±1.2 to 7.5±1.3 min (P<0.001). In each case, the percentage improvement was significantly greater than the improvement seen in the control population. Dietary evaluation revealed no significant change in caloric or protein intake, despite a subjectively improved appetite. r-HuEPO, given by the s.c. route, corrects the anemia and improves the exercise capacity of pediatric patients receiving long-term peritoneal dialysis.