Assessment of Iron Status in Anemic Children with Chronic Kidney Disease

Abstract

Background: Iron deficiency is the commonest cause of resistance to erythropoiesis stimulating agents (ESAs) in dialyzed children treated from anemia of chronic kidney disease (CKD). Aim of the work: This study was conducted in order to evaluate the significance of different biomarkers in assessment of iron status during management of anemic children with CKD. Patients and method: Twenty five children with diagnosis of anemia of chronic kidney disease were enrolled for the study. They were classified into two groups according to their stage of the kidney disease. Group I; included 15 children with anemia of CKD and their Glomerular Filtration Rate (GFR) was 15.5 – 29.6 ml/min/1.73m2 (stages; III & IV CKD) and they were managed conservatively. Group II; It included 10 anemic children with end stage renal disease (Stage V CKD, GFR was 6.1 – 13.7 ml/min/1.73m2) and they were under regular hemodialysis. Another 10 healthy children with matched age and gender served as control group (group III). Results: The study showed that the hypochromic cell percentage was significantly higher in both groups I and II before treatment when compared to controls (p <0.0001). Serum ferritin showed very high significant elevation in all the studied groups as compared to controls, also group II was highly significant when compared with group I before treatment. Improvement of iron mobilization and metabolism after 8 weeks of therapy with intravenous iron and erythropoietin was evidenced by significant increase in hemoglobin (Hb) level, RBCs and HCT % when comparing the group II patients before and after treatment. Also significant decrease in hypochromic cell percentage and increase in serum ferritin were proved. The sTfR and sTfR/ F indices showed elevation in the post-treatment group. Conclusion: No single biomarker is reliable alone in the assessment and monitoring the iron status in anemic patients with CKD under ESAs therapy. Measurement of hypochromic cell percentage may be simple and reliable method, and sTfR represents a valuable quantitative assay of marrow erythropoietic activity as well as a marker of tissue iron deficiency. However, the sTfR / Ferritin index is considered to be more efficient in anemic patients with CKD for early prediction of functional iron deficiency and is a sensitive tool for follow up of iron status during ESAs therapy.