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Response to oral iron therapy in children with anemia of chronic kidney disease

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Abstract

Background

Anemia is a common complication of chronic kidney disease (CKD) and oral iron is recommended as initial therapy. However, response to iron therapy in children with non-dialysis CKD has not been formally assessed.

Methods

We reviewed medical records of pediatric patients with stages II–IV CKD followed in two New York metropolitan area medical centers between 2010 and 2020 and identified subjects who received oral iron therapy. Response to therapy at follow-up visits was assessed by improvement of hemoglobin, resolution of anemia by the 2012 KDIGO definition, and changes in iron status. Potential predictors of response were examined using regression analyses (adjusted for age, sex, eGFR, and center).

Results

Study criteria were met by 65 children (median age 12 years, 35 males) with a median time between visits of 81 days. Median eGFR was 44 mL/min/1.73 m2, and 40.7% had glomerular CKD etiology. Following iron therapy, hemoglobin improved from 10.2 to 10.8 g/dL (p < 0.001), hematocrit from 31.3 to 32.8% (p < 0.001), serum iron from 49 to 66 mcg/dL (p < 0.001), and transferrin saturation from 16 to 21.4% (p < 0.001). There was no significant change in serum ferritin (55.0 to 44.9 ng/mL). Anemia (defined according to KDIGO) resolved in 29.3% of children. No improvement in hemoglobin/hematocrit was seen in 35% of children, and no transferrin saturation improvement in 26.9%. There was no correlation between changes in hemoglobin and changes in transferrin saturation/serum iron, but there was an inverse correlation between changes in hemoglobin and changes in ferritin. The severity of anemia and alkaline phosphatase at baseline inversely correlated with treatment response.

Conclusions

Anemia was resistant to 3 months of oral iron therapy in ~ 30% of children with CKD. Children with more severe anemia at baseline had better treatment response, calling for additional studies to refine approaches to iron therapy in children with anemia of CKD and to identify additional predictors of treatment response.

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Data Availability

Relevant data will be made available upon reasonable request, assuring confidentiality of study participants.

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Funding

Regulatory and data management support for this study was partially provided by the Weill Cornell Medicine Clinical and Translational Science Center (funded by the NIH NCATS UL1TR002384). O.A. is supported by the R03 DK135897 and K08 DK114558 from the NIH NIDDK, the Hartwell Foundation, the Sy Syms, and the Bass Foundations. The content does not necessary represent the official views of any of the supporting entities.

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Author notes

  1. Kelly Meza and Sharmi Biswas contributed equally to this work.

Authors and Affiliations

  1. Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA

    Kelly Meza, Sharmi Biswas, Kanza Baqai & Oleh Akchurin

  2. Westchester Medical Center, Valhalla, NY, USA

    Chantal Talmor, Dmitry Samsonov & Sonia Solomon

  3. New York-Presbyterian Hospital, New York, NY, USA

    Oleh Akchurin

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  1. Kelly Meza
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Correspondence to Oleh Akchurin.

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The results of this study were partially presented at the 54th Annual Scientific Meeting of the European Society of Pediatric Nephrology (ESPN) in Ljubljana, Slovenia (June 2022), and at the 19th International Pediatric Nephrology Association (IPNA) Congress in Calgary, Canada (September 2022).

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Meza, K., Biswas, S., Talmor, C. et al. Response to oral iron therapy in children with anemia of chronic kidney disease. Pediatr Nephrol 39, 233–242 (2024). https://doi.org/10.1007/s00467-023-06048-z

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