Thapa Bishnu Kumar, Bhatia Prateek, Meena Jitendra, Dawman Lesa, Tiewsoh Karalanglin
Pediatric Nephrology Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Pediatric Hemato-Oncology Unit, Department of Pediatrics, Post-Graduate Institute of Medical Education and Research, Chandigarh, India.
Clin Exp Nephrol. 2023 Jan;27(1):66-71. doi: 10.1007/s10157-022-02281-2. Epub 2022 Oct 3.
Anemia in chronic kidney disease (CKD) is multifactorial. The presence of functional iron deficiency (FID), whereby, there is a block in the transport of iron from macrophage to erythroid marrow is one possible etiology. In this study, we aim to assess the prevalence and risk factors of FID in pediatric CKD.
A cross-sectional study was performed from March to December 2018, after obtaining Institute Ethical Clearance. Children aged ≤ 12 years with CKD, with or without iron supplementation who consented were enrolled. Patients on erythropoietin or on maintenance dialysis were excluded. Details of patients and diseases characteristics were recorded. Various laboratory parameters including complete blood count, red blood cell indices, hypochromic RBC, reticulocyte hemoglobin content, and serum ferritin were measured. Appropriate statistical tests were applied.
Out of 174 children, 127 (73%) had structural kidney disease as an etiology of CKD, and 110 (63%) had anemia. Prevalence of anemia was 44%, 43%, 74%, 64% and 92% in CKD stage 1, 2, 3, 4 and 5, respectively. Absolute iron deficiency was found in 66 (38%) even when some children were already on iron supplementation. FID was seen in 44 (25%) and on multivariate analysis, lower estimated glomerular filtration rate and mineral bone disease are associated risk factors.
FID is present in one-fourth of our CKD cohort. It should be considered when the response to adequate measures of improving hemoglobin level fails. More studies are required to know its impact on short-term and long-term patient-related outcomes such as quality of life and mortality.
慢性肾脏病（CKD）中的贫血是多因素导致的。功能性缺铁（FID）的存在是一种可能的病因，即铁从巨噬细胞向红系骨髓的转运存在障碍。在本研究中，我们旨在评估儿童CKD中FID的患病率及危险因素。
在获得机构伦理批准后，于2018年3月至12月进行了一项横断面研究。纳入年龄≤12岁、同意参与的CKD儿童，无论其是否补充铁剂。排除接受促红细胞生成素治疗或维持性透析的患者。记录患者及疾病特征的详细信息。检测包括全血细胞计数、红细胞指数、低色素红细胞、网织红细胞血红蛋白含量及血清铁蛋白在内的各项实验室参数。应用适当的统计学检验。
174名儿童中，127名（73%）的CKD病因是结构性肾脏疾病，110名（63%）患有贫血。CKD 1、2、3、4和5期的贫血患病率分别为44%、43%、74%、64%和92%。即使一些儿童已经在补充铁剂，仍有66名（38%）存在绝对缺铁。44名（25%）存在FID，多因素分析显示，较低的估计肾小球滤过率和矿物质骨病是相关危险因素。
我们的CKD队列中有四分之一存在FID。当改善血红蛋白水平的适当措施效果不佳时应考虑到这一点。需要更多研究来了解其对患者短期和长期相关结局（如生活质量和死亡率）的影响。
