ESPN 54th Annual Meeting

ESPN 2022


 
RESPONSE TO ORAL IRON THERAPY IN CHILDREN WITH CHRONIC KIDNEY DISEASE
KELLY MEZA 1 Sharmi Biswas 1 Chantal Talmor 3 Dmitry Samsonov 2 Sonia Solomon 2 Oleh Akchurin 1

1- WEILL CORNELL MEDICAL COLLEGE
2- Westchester Medical Center
3- Northwell Health
 
Introduction:

Anemia is a common complication of CKD and oral iron is recommended as the initial therapy. However, response to iron therapy in children with pre-dialysis CKD remains poorly investigated.

Material and methods:

We reviewed medical records of children with CKD stages I-IV in two New York metropolitan area medical centers from 2010 to 2020 and identified clinic visits at which iron therapy was initiated, as well as the follow up visit. Response to iron therapy was assessed using improvement of anemia, resolution of anemia using KDIGO definition, and changes in iron status (the latter was also used as a measure of compliance). Potential predictors of therapy response were assessed using regression analyses (adjusted for age, sex, and GFR).

Results:

Study criteria were met by 65 children (35 males) with average time between visits 102 days. The average GFR was 52.1 mL/min/1.73m2, 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), transferrin saturation from 16 to 21.4% (p<0.001). There was an insignificant decrease of serum ferritin (55.0 to 44.9 ng/mL). Anemia has 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 a negative correlation between changes in hemoglobin and changes in ferritin (r=-0.37, p=0.03). The severity of anemia and alkaline phosphatase at baseline correlated with treatment response.

Conclusions:

 Anemia was resistant to three months of oral iron therapy in ~30% of children with CKD. Resistance did not appear to be related to non-compliance or CKD severity. Prospective and/or larger retrospective studies are needed to determine additional predictors of response to iron therapy in CKD.