Functional iron deficiency in children with Chronic Kidney Disease presenting to a tertiary center

Medicine/ pediatrics

Background : Anemia is one of the most common and clinically significant complications of Chronic Kidney Disease (CKD) in children and is associated with a variety of adverse clinical consequences, including an increased risk for hospitalization and mortality. The predominant causes are erythropoietin deficiency, lack of iron availability, inflammation, blood loss, hyperparathyroidism, and vitamin deficiency B12 and folate. Functional iron deficiency (FID), is the state of insufficient iron utilization by bone marrow erythroid precursor cells despite adequate iron stores. Methods: This was a cross sectional study conducted in the Department of Pediatrics, PGIMER, Chandigarh, India from July 2017 to December 2018 consisting 190 patients after ethical clearance from institutional Ethic committe. The demographic and clinical details were taken and laboratory investigation regarding, hemogram, iron profile, Calcium, phosphorous, Vitamin D, Parathyroid hormone, Venous blood gas were done. The analysis was done by SPSS version 16. Results: Out of 190 patients enrolled in the study 145 were male and 45 females. CKD was more common in boys with a sex ratio of 3.2:1 and mean age of diagnosis of CKD was 6.49±4.04 years. The most common stage of CKD at presentation was stage I CKD 32.6% (N=62) followed by stage III CKD 19.5% (N=37) and stage V CKD 19.5% (N=37).Most of them had structural kidney disease. Anemia was present in in 62.6% (N=119). The prevalence of functional iron deficiency in our children was 38.37% (N=66) out of 172 CKD children tested) of CKD children .Percentage of hypochromic red cells(HRC) >6 % was present in 29 patients (out of 142 tested). Reticulocyte hemoglobin content (CHr ) <29 pg in 97 CKD children (out of 140 tested). 54 patients had ferritn level >100 ug/L if not on dialysis and >200 ug/L if on dialysis (out of 153 tested). Conclusions: CKD was more common in boys with etiology being structural kidney disease. The prevalence of functional iron deficiency was 38.37%. This number signifies that significant number of our CKD children are anemic. We emphasis the need to improve multiple aspects of CKD management, including early diagnosis and treatment of anemia.

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