Whether uncontrolled anemia in children with CKD affects their prognosis and what the normal Hb levels are in children with CKD also remain unclear. Anemia in children with CKD strongly affects the cardiovascular system as well as the kidneys. In Selleckchem ACY-738 particular, it causes left ventricular failure, leading to prolonged hospital stays, and eventually to a higher mortality rate. It has been reported that early therapeutic intervention contributes to a child’s growth and

improves IQ and QOL. Therefore, treatment should be administered if the find more patient has been diagnosed with anemia. Treatment should continue until the Hb value exceeds 11 g/dL. Note, however, that although the upper limit of the Hb value in children has not yet been set, Hb values in adults are defined such that one should not intentionally exceed 13 g/dL. In addition, adequate attention should also be paid to such problems as hypertension and vascular access troubles in the treatment of anemia in children with CKD (Tables 18, 19). Table 18 Normal Hb values for children(g/dL)   Boys Girls Mean SD <5th percentile Mean SD <5th percentile 1 year< 14.7 1.4 12.1 13.2 1.1 11.4 1–2 years 12.0 0.8 10.7 12.0 0.8 10.8 3–5 years

12.4 0.8 11.2 12.4 0.8 11.1 6–8 years 12.9 0.8 11.5 12.8 0.8 11.5 9–11 years 13.3 0.8 12.0 13.1 0.8 11.9 12–14 years 14.1 1.1 12.4 13.3 1.0 11.7 15–19 years 15.1 1.0 13.5 13.2 1.0 11.5 NHANESIIIdata, United States, 1988–1994 Table 19 Normal Hb values for infants(g/dL)   Mean −2 SD* Term 16.5 13.5 1–3 days 18.5 14.5 1 week 17.5 13.5 2 weeks

4SC-202 research buy 16.5 12.5 1 month 14.0 10.0 2 months 11.5 9.0 3–6 months 11.5 9.5 6–24 months 12.0 10.5 Nathan and Oski’s Hematology of Infancy and Childhood (ed 6) Bibliography 1. Filler G, et al. Pediatr Nephrol. 2007;22:702–7. (Level 4)   2. Singh BCKDHA AK, et al. N Engl J Med. 2006;355:2085–98. (Level 2)   3. Pfeffer MA, et al. N Engl J Med. 2009;361:2019–32. (Level 2)   4. Jabs K. Pediatr Nephrol. 1996;10:324–7. (Level 2)   5. Warady BA, et al. Pediatr Nephrol. 2003;18:1055–62. (Level 4)   6. Warady BA, et al. Pediatr Nephrol. 2006;21:1144–52. (Level 2)   Is treatment of growth retardation with recombinant human growth hormone (rhGH) recommended for children with CKD? Growth impairment is one of the major visible complications of CKD in children. Currently, rhGH is used to treat growth impairment in children with CKD and is covered by health insurance in Japan. A concern is whether rhGH therapy should be administered to all children with CKD who have growth impairment. Various randomized controlled trials reported that adequate growth in stature was obtained in 2 or 3 years after the start of rhGH treatment. We recommend administering rhGH at 28 IU/m2/week (or approximately 0.35 mg/kg/week).