Anemia in Children With Chronic Renal Failure

Anemia is a common finding in children with chronic renal failure (CRF) due to the decreased production of erythropoietin when glomerular filtration rate diminishes below 35 mL/min/1.73m2. Red blood cells are normocytic and normochromic in renal anemia. Causes of anemia in children with CRF are iron deficiency, recombinant human erythropoietin dose insufficiency, intestinal blood losses, acute and/or chronic inflammation, secondary hyperparathyroidism and nutritional deficiencies. Anemia has significant effects on the quality of life. Untreated anemia may lead to cardiac complications, increased risk of hospitalization and serious mortality. Ideal hemoglobin and hematocrit levels for children with CRF are 11-12 g/dL and 33-36% respectively. Clinical findings of anemia, such as decreased appetite, loss of energy, impaired cardiac functions and poor school performance, may improve with appopriate approach and therapy of renal anemia. Management of renal anemia is discussed in this article.