• Khemchand N Moorani
  • Sadaf Asim


Background: Erythropoietin (Epo) and iron therapy plays a major role in the management of renalanaemia. Iron sucrose (IS) has been used to treat iron deficiency anaemia (IDA) and to maintainadequate iron store in chronic kidney disease (CKD). The objective of the study was to determine theresponse and safety of IS in the treatment of IDA. Methods: This retrospective study was carried out inthe Department of Nephrology, National Institute of Child Health, Karachi from Dec 2008 to Dec 2010.Children aged 6 months to 14 years, CKD-stage 2–5, and IDA were included. Pertinent data includingage, gender, serum creatinine (SCr), CKD-stage, aetiology, treatment mode, IS dose, pre- and posttreatment parameters and side effects were collected and analysed. Results: Among 35, majority (66%)were boys. Mean age was 6.97±4.13 years and mean SCr was 3.78±3.1 mg/dl. Majority were in CKDstage 4–5 and treated conservatively. Major aetiologies were hypoplasia-dysplasia (40%), juvenilenephronophthiasis (17.14%), posterior urethral valves, and stones. Baseline mean Hb and TransferrinSaturation (TS) was 7.38±1.38 g/dl and 11.19±5.28% respectively. Mean Hb increased to 9.22±16.32g/dl with correction of iron deficit (p<0.001) and a sustained rise in Hb was observed after Epo andmaintenance iron sucrose. Mean TS% increased to 49.13±18% (p<0.001). No major side effects wereobserved except iron overload. Conclusion: Iron sucrose was effective in improving IDA in CKDwithout significant side effects. Iron sucrose may be used to treat IDA with monitoring for iron overload.Keywords: Iron deficiency, anaemia, iron sucrose, chronic kidney disease


Ramzan A, Moorani KN. Pattern of renal diseases in children. J

Surg Pak Intern 2001;6.4:9–12.

Iqbal J, Rehman MA, Khan MA. Pattern of renal diseases in

children. J Pak Med Assoc 1994;44:118–20.

Warady BA, Ho M. Morbidity and mortality in children with

anaemia at initiation of dialysis. Pediatr Nephrol 2003;18:1055–62.

Staples AO, Wong CS, Smith JM, Gipson DS, Filler G, Warady

BA, et al. Anemia and Risk of Hospitalization in Pediatric

Chronic Kidney Disease. Clin J Am Soc Nephrol 2009;4:48–56.

KDOQI, National Kidney Foundation. III Clinical Practice

recommendations for anaemia in chronic kidney disease in

children. Am J Kidney Dis 2006;47(Suppl 3):S86–108.

Wong H, Mylrea K, Feber J, Drukkar A, Filler G. Prevalence of

complications in children with chronic kidney disease according

to KDOQI. Kidney Int 2006;70:585–90.

Koshy SM, Geary DF. Anemia in children with chronic kidney

disease. Pediatr Nephrol 2008;23:209–19.

Boehm M, Riesenhuber A, Winkelmayer WC, Arbeiter K,

Mueller T, Aufricht C. Early erythropoietin therapy is associated

with improved growth in children with chronic kidney disease.

Pediatr Nephrol 2007;22:1189–93.

Gerson A, Hwang W, Fiorenza J, Barth K, Kaskel F, Weiss L, et

al. Anemia and health related quality of life in adolescent with

chronic kidney disease. Am J Kidney Dis 2004;44:1014–23.

Fadrowski JJ, Pierce CB, R Cole SR, Mims MM, Warady BA,

Furth SL. Hemoglobin decline in children with chronic kidney

disease: Baseline results from the Chronic Kidney Disease in

children prospective cohort study. Clin J Am Soc Nephrol

;3(2);457–62. Epub 2008 Jan 30.

Gotloib L, Silverberg D, Fudin R, Shostak A. Iron deficiency is a

common cause of anaemia in chronic kidney disease and can

often be corrected with intravenous iron. J Nephrol


Keithi-Reddy SR, Singh AK. Hemoglobin target in chronic

kidney disease a pediatric prospective. Pediatr

Nephrol 2009;24:431–4.

Schwartz AB, Parsad V, Garcha J. Anemia of chronic kidney

disease: A combined effect of marginal iron stores and

erythropoietin deficiency. Dialysis and Transplant


Warady BA, Kausz A, Lerner G, Brewer ED, Chadha V,

Brugnara C, et al. Iron therapy in the pediatric hemodialysis

population. Pediatr Nephrol 2004;19:655–61.

Schiesser D, Binet I, Tsinalis D, Dickenmann M, Keusch G,

Schmidli M, et al. Weekly low-dose treatment with intravenous

iron sucrose maintains iron status and decreases epoetin

requirement in iron-replete hemodialysis patients. Nephrol Dial

Transplant 2006;21:2841–5.

Ardissino G, Dacco V, Testa S, Bonaudo B, Claris-Appiani A,

Taioli E, et al. Epidemiology of Chronic Renal Failure in

Children: Data From the ItalKid Project Pediatrics


Molla A, Khurshid M, Molla AM. Prevalence of iron deficiency

anaemia in children of the urban slums of Karachi. J Pak Med

Assoc 1992;42:118–21.

Coyne DW. Hepcidin: clinical utility as a diagnostic tool and

therapeutic target. Kidney Int 2011;80:240–4.

Atkinson MA, White CT. Hepcidin in anaemia of chronic kidney

disease: review for the pediatric nephrologist. Pediatr Nephrol


Bamgabola O. Resistance to erythropoietin–stimulating agents:

aetiology, evaluation and therapeutic considerations. Pediatr

Nephrol 2012;27:195–205.

Jai Ram A, Das R, Aggarwal PK, Kohli HS, Gupta KL, Sakhuja

V, et al. Iron status, inflammation and hepcidin in ESRD patients.

The confounding role of intravenous iron therapy. Indian J

Nephrol 2010;20:125–31.

Hörl WH. Iron therapy for renal anaemia: How much needed,

how much harmful? Pediatr Nephrol 2007;22:480–9.

Akhtar N, Tahir MM, Kiran S. Recombinant human

erythropoietin therapy in predialysis patients of chronic kidney

disease. Nephrol Reviews 2010;2:43–6.

Iqbal MM, Malik BA. Parenteral iron therapy in malnourished

children. Pakistan Armed Forces Med J 2006;56:271–5.

Afzal M, Qureshi SM, Lutafullah M, Iqbal M, Sultan M, Khan SA.

Comparative study of efficiency, tolerability and compliance of oral

iron preparations and intramuscular iron sorbitol in iron deficiency

anaemia in children. J Pak Med Assoc 2009;59:764–8.