Abstract
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.