Anemia in patients with CKD is not always caused by erythropoietin deficiency alone. Initial laboratory evaluation therefore is aimed at identifying other factors that may cause or contribute to anemia or lead to ESA hyporesponsiveness.
1.2.1 In the opinion of the Work Group, initial assessment of anemia should include the following tests: (APPLICABLE TO CHILDREN, BUT NEEDS MODIFICATION)
1.2.1.1 A CBC including—in addition to the Hb concentration—red blood cell indices (MCH, MCV, MCHC), white blood cell count and differential and platelet count.
1.2.1.2 Absolute reticulocyte count.
1.2.1.3 Serum ferritin to assess iron stores.
1.2.1.4 ADULT CPR
Serum TSAT or CHr to assess adequacy of iron for erythropoiesis.
PEDIATRIC CPR
In the pediatric patient, serum TSAT to assess adequacy of iron for erythropoiesis.
There is no evidence to support any different recommendations in children compared with adults with respect to statements 1.2.1.1 through 1.2.1.3. However, tests other than TSAT that are included in the recommendation for assessment of iron available for erythropoiesis in adults have not been well studied in the pediatric CKD population, with only 2 studies examining the use of CHr in HD patients304,305 and none evaluating the use of PHRCs. This would seem to suggest that until further data are available, these tests remain research-based methods in children with CKD.