Kinetics, Dialysis Systems, and Adequacy Copper deficiency: A common cause of erythropoietin (rHuEPO) resistant anemia in children on hemodialysis (HD)?
Bibliographic record
Abstract
Copper (CU) deficiency, as reflected by a low serum CU and ceruloplasmin (CER) level, is a rare complication of chronic HD. When present, common clinical manifestations include anemia and neutropenia. Anecdotally, CU deficiency has been linked to the use of sevelamer hydrochloride (SH), a recently introduced phosphate binding agent. The finding of severe CU deficiency and rHuEPO‐resistant anemia in 3 of our patients (pts) prompted a review of our entire pediatric HD population for the frequency of CU deficiency and its possible relationship to SH. An assessment of serum CU was conducted in 17 pts (male‐11; mean age 169.4 + 49.6 mo) who had received HD for 21.5 + 33.9 months. All pts received three 4‐hour HD sessions weekly with mean single‐pool and equilibrated Kt/V values of 2.29 + 2.5 and 1.56 + 0.37, respectively. 14 of 17 (82%) pts had low serum CU levels with a mean value of 69.1 + 38.3 mcG/DL (normal = 85–150 mcG/DL). 9 of 17 (53%) pts had values <60 mcG/DL and 3 pts had values <25 mcG/DL with CER values of 1.2 mg/dL, 0.6 mg/dL, and 1.8 mg/dL, respectively (normal = 24–40 mg/dL). In the latter 3 pts, hemoglobin values fell to 5.4 gm/dL, 5.2 gm/dL, and 9.2 gm/dL despite regular rHuEPO dosing and adequate iron stores and all pts responded to supplemental CU therapy. The mean hemoglobin of the remaining 14 pts was 11.7 + 1.3 gm/dL. Whereas 13 of 14 (93%) CU deficient pts were receiving SH (142.1 + 112.3 mg/kg/d) for 331.0 + 293.6 days at the time of the CU assessment, there was no significant relationship demonstrated between the dose of SH or the duration of SH therapy and the serum CU level. In conclusion, CU deficiency appears to commonly occur in pediatric HD pts with extremely low values associated with profound anemia responsive to CU therapy. While the chronology of CU deficiency and the introduction of SH suggests an association, additional research is necessary to address this issue in a more definitive manner.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".