Abstract

We describe a case of a patient with Chronic Kidney Disease who developed polycythemia due to Erythrocyte stimulating agents overuse during COVID-19 isolation. A 12-year-old male had not been able to attend routine controls since had been in isolation for 4 months after the COVID-19 outbreak. He had continued to take ESA during that period at the starting dose of 150 U/kg/week. He had been on peritoneal dialysis in the last year because of end-stage renal failure. Laboratory investigation revealed a hemoglobin (Hb) level of 20.8 g/dl, hematocrit level of 66%, creatinine level of 6.5 mgr/dl. He underwent daily phlebotomy sessions (10cc/kg/session). During this period aspirin was also started (5mg/kg). After 5 sessions his Hb level decreased to 14 gr/dl and hematocrit to 40%. Pediatric nephrologist should being aware that there is a potential risk of polycythemia with ESA when Hb level is not appropriately followed on a routine basis.

Keywords: Chronic Kidney Disease, Erythrocyte stimulating agent, Polycythemia

References

  1. 1. Stauffer ME, Fan T. Prevalence of anemia in chronic kidney disease in the United States. PLoS One. 2014; 9:e84943.
  2. 2. National Kidney Foundation: NKF-DOQI. Clinical practice guidelines for the treatment ofAnemia of chronic renal failure. New York, National Kidney Foundation. AmJ Kidney Dis 2006;47:S11–S145
  3. 3. Robinson N, Giraud S, Saudan C, Baume N, Avois L, Mangin P, Saugy M. Erythropoietin and blood doping. British Journal of Sports Medicine. 2006;40:Supplement 1, pp. i30–i34.
  4. 3. Ibrahim HN, Ishani A, Foley RN, Guo H, Liu J, Collins AJ. Temporal trends in red blood transfusion among US dialysis patients, 1992-2005. Am J Kidney Dis. 2008;52:1115-1121.
  5. 4.WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues, revised 4th edition, Swerdlow SH, Campo E, Harris NL, et al. (Eds), International Agency for Research on Cancer (IARC), Lyon.2017
  6. 5. Lawler EV, Bradbury BD, Fonda JR, Gaziano JM, Gagnon Dr. Transfusion burden among patients with chronic kidney disease and anemia. Clin J Am Soc Nephrol 2010;5:667-672.
  7. 6. KDOQI. KDOQI Clinical Practice Guideline and Clinical Practice Recommendations for anemia in chronic kidney disease: 2007 update of hemoglobin target. Am J Kidney Dis 2007 50: 471-530.
  8. 7. Parapia LA. History of bloodletting by phlebotomy. Br J Haematol 2008;143: 490-495.
  9. 8. Fallah M, Kharazmi E, Sundquist J, Hemminki K. Higher risk of primary cancers after polycythaemia vera and vice versa. Br J Haematol 2011;153: 283-285.
  10. 9. Research C for DE and. Drug Safety and Availability - FDA Drug Safety Communication: Modified dosing recommendations to improve the safe use of Erythropoiesis-Stimulating Agents (ESAs) in chronic kidney disease .
  11. 10. Berk PD, Wasserman LR, Fruchtman SM, Goldberg JD. Treatment of polycythemia vera: a summary of clinical trials conducted by the Polycythemia Vera Study Group. In: Polycythemia Vera and the Myeloproliferative Disorders, Wasserman LR, Berk PD, Berlin NI (eds), WB Saunders, Philadelphia;1995; p.166

Copyright and license

How to cite

1.
Kandur Y, Alpcan A, Yozgat M, Tursun S. Polycythemia in a Pediatric Patient with Chronic Kidney Disease: Overuse of Erythropoerin Due COVID-19 Isolation. Turk J Pediatr Dis [Internet]. 2021 Sep. 23 [cited 2025 May 25];15(5):434-6. Available from: https://turkjpediatrdis.org/article/view/765