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Kidney Week

Abstract: PO0284

Response to Oral Iron Therapy in Children with Anemia of CKD

Session Information

Category: Anemia and Iron Metabolism

  • No subcategory defined

Authors

  • Biswas, Sharmi, Weill Cornell Medicine, New York, New York, United States
  • Meza, Kelly, Weill Cornell Medicine, New York, New York, United States
  • Aljayyousi, Haneen, Weill Cornell Medicine, New York, New York, United States
  • Samsonov, Dmitry V., Westchester Medical Center, Valhalla, New York, United States
  • Solomon, Sonia, Westchester Medical Center, Valhalla, New York, United States
  • Perelstein, Eduardo M., Weill Cornell Medicine, New York, New York, United States
  • Kumar, Juhi, Weill Cornell Medicine, New York, New York, United States
  • Akchurin, Oleh M., Weill Cornell Medicine, New York, New York, United States

Group or Team Name

  • Pediatric Nephrology
Background

Anemia is a common complication of chronic kidney disease (CKD). Current guidelines recommend oral iron therapy as the initial treatment of anemia in CKD. However, the efficacy of iron therapy in children with pre-dialysis CKD has not been evaluated. Factors determining the response to oral iron in pediatric CKD remain poorly understood.

Methods

An ongoing retrospective observational study. Data were abstracted from health records of children with pre-dialysis CKD at the time of iron therapy initiation and at the next clinic visit and compared using paired T-test. Children receiving erythropoiesis-stimulating agents were excluded. Response to iron therapy was defined as improvement in both hemoglobin and hematocrit after iron therapy. Changes of serum iron were used as a surrogate measure of adherence to iron therapy. Data are presented as median (interquartile range).

Results

We identified 44 children (48% boys) who met the inclusion criteria. Median age was 11 (5-15) years, glomerular filtration rate (GFR) 46 (31-60) mL/min/1.73m2. Ferrous sulfate was used in 86.4% of children. The interval between visits was 61 (31-120) days. Iron therapy resulted in a significant increase in transferrin saturation (14 to 21%, p<0.001) and serum iron (45 to 65 μg/dL, p<0.001). While there was an overall improvement of hemoglobin (from 10.6 to 11.2 g/dL, p=0.02), 45% of children did not respond to iron therapy. Non-responders had a significantly smaller change in serum iron after iron therapy compared to responders (3 vs. 35 μg/dL, p=0.03), likely indicating low adherence to iron therapy by non-responders. Baseline age, GFR, hemoglobin, transferrin saturation, serum iron, and serum ferritin were not different between responders and nonresponders. Baseline body weight and height Z scores were significantly lower in non-responders than in responders (-0.67 vs. 0.12, p=0.04 and -1.66 vs. -0.25, p=0.02, respectively), possibly representing differences in nutritional status.

Conclusion

This is the first study that systematically assesses response to oral iron therapy in children with pre-dialysis CKD after 2012 Kidney Disease Improving Global Outcomes (KDIGO) guidelines. Response to iron therapy may be related to medication adherence and baseline nutritional characteristics of study participants.