Correlation between Glomerular Filtration Rate And Serum Erythropoietin Level in Children with Advanced (Stages 3 to 5) Chronic Kidney Disease with Anemia: A Cross-sectional Study

Open Access

Abstract

Introduction: Advanced CKD (stages 3 to 5) is commonly associated with worsening anemia due to progressive nephron loss and decreased renal EPO synthesis. The optimal glomerular filtration rate (GFR) for initiating anemia treatment with erythropoietin-stimulating agents (ESAs) remains unclear. This study aims to explore the correlation between GFR in advanced CKD with anemia and serum erythropoietin (EPO) levels. Understanding this relationship could facilitate the timely initiation of ESAs and improve the early management of anemia and its associated complications. Aim of the Study: To assess the relation of Glomerular Filtration Rate (GFR) with serum level of erythropoietin (EPO) in children with advanced stages of CKD (Stages 3 to 5) with anemia. Methods & Materials: This cross-sectional study was done in BSH&I on forty children with advanced CKD (Stages 3 to 5) having anemia. The diagnosis of CKD and renal anemia was done according to KDIGO (2012) guidelines. GFR was estimated using the revised Schwartz formula and Serum erythropoietin levels were measured using the enzymatic-chemiluminescent immunometric (CLIA). The Pearson correlation coefficient was used to assess the relationship between GFR and serum EPO levels. Results: Out of 40 study participants 20% had severe anemia. Among them, 12.5% were in CKD Stage 4 and 87.5% in Stage 5. The mean serum EPO levels did not significantly increase in Stage 3 (14.98 ± 4.63 mIU/mL, p< 0.01) in response to anemia as well as hypoxic condition whenever EPO levels decreased in Stage 4 (6.83 ± 2.66 mIU/mL, p< 0.01) and Stage 5 (4.88 ± 1.34 mIU/mL, p< 0.01). The result also showed a significant positive correlation between GFR and serum erythropoietin levels (r= 0.7296, p <0.05). As GFR decreases, reflecting worsening kidney function, serum EPO levels also decline. Conclusion: This study highlighted a significant dysregulation of erythropoietin in advanced CKD with anemia, more in Stage 4 and Stage 5. This correlation may help to optimize anemia management in pediatric CKD patients.