NORMALIZATION OF HEMATOCRIT IN PATIENTS WITH CRF

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This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Anemia is a major complication associated with chronic renal (kidney) failure. Prior studies have shown that anemia in children with chronic renal failure may cause decreased school performance. This anemia can be treated with recombinant human erythropoetin (r-HU EPO). Current standards will allow for the correction of anemia to a goal hematocrit of between 33-36%. Normal hematocrit levels for children range from 40-44%. Our hypothesis is that the normalization of hematocrit, by increasing the r-HU EPO dose described, will improve cognitive functioning. Anemic pediatric patients between the ages of 6-19 years with chronic renal failure will have formal cognitive functioning studies administered. These studies include a Wechsler intelligence score to test intelligence, Digit Span to test memory, and Continuous Performance Test to measure vigilance. These studies will be conducted when the patient has a hematocrit of 30% or less, when the patient's hematocrit has been raised to 33-36% and once again when it has been raised to 40-44%. Each patient will be kept stable at the respective hematocrits for three months in order to establish stabilization of the hematocrit. Hematocrit levels will be monitored on a monthly level as part of routine medical care. Iron levels will also be obtained upon enrollment into the study to eliminate iron deficiency as a contributor to the anemia. In order to eliminate test familiarity as a factor in the results, control patients will be patients with chronic renal failure without anemia, so the patients do not have the need for r-HU EPO therapy.