Anemia in Children with Chronic Kidney Disease

Anemia is a common and significant complication in children with chronic kidney disease (CKD), which increases in prevalence as the disease progresses. Studies from the North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS) report that up to 60% of children with CKD stage G2 and over 80% of those with CKD G5 are affected by anemia. This condition contributes to a range of clinical manifestations, including fatigue, pallor, and cognitive impairment and increases the need for blood transfusions and hospitalizations, thereby increasing morbidity and mortality. The etiology of anemia in CKD is multifactorial, involving erythropoietin (EPO) deficiency, iron deficiency, inflammation, blood loss, and the effects of medications. The Kidney Disease Outcomes Quality Initiative (KDOQI) and Kidney Disease: Improving Global Outcomes (KDIGO) have issued guidelines for anemia management, which emphasize the need for individualized treatment strategies, such as erythropoiesis-stimulating agents (ESAs) and iron supplementation. However, challenges remain regarding optimal hemoglobin targets, and ongoing research is needed to balance the benefits of ESAs with potential cardiovascular risks. This review highlights the complexities of anemia in pediatric CKD, the role of key factors such as erythropoietin and iron in red blood cell maturation, and the importance of a tailored approach to treatment to improve patient outcomes.