KDOQI (Kidney Disease Outcomes Quality Initiative)
NKF KDOQI GUIDELINES

KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for Anemia in Chronic Kidney Disease


III. CLINICAL PRACTICE RECOMMENDATIONS FOR ANEMIA IN CHRONIC KIDNEY DISEASE IN CHILDREN

CLINICAL PRACTICE RECOMMENDATIONS FOR ANEMIA IN PEDIATRIC PATIENTS WITH CKD

INTRODUCTION
Presentation of clinical practice recommendations for anemia in pediatric patients with CKD is warranted because the pediatric patient population, from newborn through adolescence, differs substantially from the adult population in key metabolic, growth, developmental, and psychological factors.300 Nevertheless, providers caring for adult and pediatric patients with CKD largely share the same topics of concern regarding the diagnosis and management of anemia. Moreover, the bulk of information to support CPRs and the only evidence of sufficient strength to support evidence-based guidelines are available from studies of the adult patient population. Given the distinct needs of pediatric patients, shared topics of concern among providers for both pediatric and adult patients, the generally low quality of evidence in pediatric patients, and the unavoidable need to generalize from evidence in adults, the Work Group chose to present CPRs in pediatric patients as a separate section, using adult guidelines as a frame of reference, changing recommendations when appropriate, and describing available evidence in pediatric patients under the guideline rationale.

Here, we address issues pertinent to children with anemia and CKD at all stages of disease. Our goal is to offer recommendations based on the best evidence available regarding issues related to the identification, diagnosis, initial evaluation, and strategies for treatment and monitoring of children with anemia and CKD stages 1 to 5, including those treated with dialysis. Our review is not exhaustive and our intent is not to substitute for textbooks. Specific details on potential dosing regimens, therapeutic choices, and practice options in caring for children with anemia and CKD are found elsewhere.301

Please note that to be consistent with the use of Hb levels, as opposed to Hct, in these new guidelines, all Hct values from studies quoted have been converted to Hb equivalents by a factor of 0.3 g/dL per percent of Hct; eg, an Hct of 33% is converted to an Hb level of 9.9 g/dL.

All statements in the pediatric section assume the preface In the opinion of the Work Group, and all statements are provided as CPRs because there is insufficient evidence in pediatric patients to support evidence-based guidelines. When, in the opinion of the Work Group, the adult guideline statement applies equally well to adults and children, the statement is accompanied by the following:
(FULLY APPLICABLE TO CHILDREN)

When, in the opinion of the Work Group, the adult guideline statement needs modification or adjustment for children, the following instruction is given, followed by the pediatric-specific guideline statement.
(APPLICABLE TO CHILDREN, BUT NEEDS MODIFICATION)