Treatment of Anemia of Chronic Kidney Disease in Children Under 18 Years

Clinical Scenario

This protocol applies to pediatric patients (age under 18 years) who have anemia in the setting of chronic kidney disease. Iron-deplete status is a key determinant of treatment initiation in this population.

Anemia Chronic Kidney Disease Age < 18 years

Treatment Approach

Iron therapy is the core intervention for iron-deplete children with CKD — with the preferred route of administration determined by the specific stage of kidney disease. The full protocol details agent selection, dosing basis, and route guidance; only a portion is shown here.

Clinical Goals

Improved hemoglobin levels
Reduced erythropoiesis-stimulating agent dose needed to maintain target hemoglobin

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References

DOI: 10.1016/j.kint.2025.06.006

In people with anemia and CKD G5HD who are initiating iron therapy, we suggest using intravenous (i.v.) iron rather than oral iron (2D).
This recommendation is also applicable to children.
1 RCT showed improved Hb levels with iron therapy in children with CKD G5HD who are iron deplete, defined as TSAT <20% and/or serum ferritin <100 ng/ml (<100 μg/l).

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