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. 2025 Dec;40(12):3725-3732.
doi: 10.1007/s00467-025-06776-4. Epub 2025 Apr 28.

Erythropoietin resistance among pediatric patients on chronic hemodialysis: A cross-sectional study

Rasha Helmy  1 , Fatina I Fadel  1 , Rasha E Galal  1 , Amira M Mohammed  1 , Shaimaa Sayed  2
Affiliations

Erythropoietin resistance among pediatric patients on chronic hemodialysis: A cross-sectional study

Rasha Helmy et al. Pediatr Nephrol. 2025 Dec.

Abstract

Background: The erythropoietin resistance index (ERI) is an accurate indicator of erythropoietin (EPO) resistance and is related to a worse prognosis in patients on hemodialysis (HD). ERI is simple, cheap and could be calculated easily in children receiving HD. We aimed to assess the EPO resistance in children with kidney failure on regular HD.

Methods: An analytical cross-sectional study was conducted on 80 children with kidney failure on regular HD. They were assessed by history taking and laboratory investigations including complete blood count, C- reactive protein (CRP), iron, ferritin, parathyroid hormone and serum electrolytes. ERI was calculated.

Results: The study included 80 patients; 41 (51.2%) were male. The mean age of the study group was 8.86 ± 2.76 years. Sixty-three patients (78.8%) were on iron therapy. Mean ERI was 28.87 ± 10.62. The ERI was significantly positively correlated with age (r = 0.242; P = 0.031), EPO dose (r = 0.290; P = 0.001) and CRP (r = 0.219; P = 0.049). The ERI had a significantly negative correlation with KT/V (r = - 0.262; P = 0.019), hemoglobin level (r = - 0.265; P = 0.001) and platelet count (r = - 0.254; P = 0.023).

Conclusions: Erythropoietin resistance is associated with many risk factors, including high CRP and low KT/V. Inadequate HD is the most important risk factor for EPO resistance in children on chronic HD. Adequate HD is considered as a protective measure against EPO resistance.

Keywords: Erythropoietin resistance; Erythropoietin resistance index; Hemodialysis; Kidney failure; Pediatrics.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study has been approved by the Research Ethics Committee, Faculty of Medicine, Cairo University (approval code: MS- 95–2022). Written informed consent was obtained from the parents or legal guardians of the children. Consent for publication: Not applicable. Competing interests: The authors declare that they have no competing interests.

Figures

None
A higher resolution version of the Graphical abstract is available as Supplementary information
Fig. 1
Fig. 1
Post hoc comparison of different primary kidney disease categories regarding erythropoietin resistance index
See this image and copyright information in PMC

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