Jamil Altaf, Gruner Barbara, Jamil Javairia, Bach Alicia, Severance Tyler, Ebersol Kim, Hesemann Laura E
Department of Pediatrics, Division of Hematology and Oncology, University of Missouri School of Medicine, Columbia, MO USA.
Gulf Medical University, Thumbay University Hospital, Ajman, United Arab Emirates.
Indian J Hematol Blood Transfus. 2025 Apr;41(2):228-237. doi: 10.1007/s12288-024-01955-z. Epub 2025 Jan 8.
A prevalent complication of chronic kidney disease (CKD), iron deficiency anemia (IDA) continues to be underdiagnosed and undertreated. Anemia in CKD in children is associated with a reduced quality of life, and an increased morbidity and mortality. The multifaceted etiology of anemia in CKD involves factors such as diminished endogenous erythropoietin (EPO) production, absolute or functional iron deficiency, and heightened inflammation characterized by elevated hepcidin levels. This paper reviews the complexities of anemia management in pediatric CKD, emphasizing the pivotal role of iron supplementation and erythropoiesis-stimulating agents (ESAs) in ameliorating erythropoiesis and optimizing patient outcomes. While intravenous (IV) iron supplementation effectively addresses iron-restricted erythropoiesis and enhances ESA response, challenges persist in accurately defining anemia in pediatric CKD patients and establishing appropriate treatment targets.
缺铁性贫血（IDA）作为慢性肾脏病（CKD）的常见并发症，其诊断和治疗仍不充分。儿童CKD患者的贫血与生活质量下降、发病率和死亡率增加有关。CKD患者贫血的多因素病因涉及内源性促红细胞生成素（EPO）生成减少、绝对或功能性缺铁以及以铁调素水平升高为特征的炎症加剧等因素。本文综述了儿童CKD贫血管理的复杂性，强调了补充铁剂和促红细胞生成剂（ESA）在改善红细胞生成和优化患者预后方面的关键作用。虽然静脉补铁能有效解决铁限制型红细胞生成并增强ESA反应，但在准确界定儿童CKD患者的贫血以及确定合适的治疗目标方面仍存在挑战。
