In patients with renal anemia, iron therapy can be administered intermittently or regularly at a low dose. We performed a randomized clinical trial in pediatric patients with end-stage renal failure on hemodialysis and absolute or functional iron deficiency. The study group received maintenance iron therapy according to the ferritin serum levels and the control group received intermittent 10-weekly doses. Success was defined as stabilization of ferritin levels between 100 and 800 microg/l and transferrin saturation (TSAT) between 20% and 50%, in addition to an increase in the hemoglobin level. The major reason for exclusion was iron overload. The study group received 6 mg/kg per month of parenteral iron [95% confidence interval (CI) 3.3-8.8] and the control group 14.4 mg/kg per month (95% CI 12-16.8) ( P<0.001). After 4 months of treatment, ferritin levels increased to 66 microg/l (95% CI 69-200) in the study group and to 334 microg/l (95% CI 145-522) in the control group ( P=0.009). Maintenance therapy and intermittent weekly doses were successful in 73% and 38%, respectively. After 3 months of treatment, hemoglobin levels increased to 10 g/dl, with no difference between the groups. However, in the control group the increase in hemoglobin levels was unsustained, and 3 patients needed transfusion. Patients in the control group had a higher risk of iron overload than patients in the study group (70% vs. 19%). Thus, the regimen based on assessment of serum ferritin levels was more efficient than the intermittent regimen because it increased and maintained the hemoglobin levels with lower iron doses and a lower risk of iron overload.

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Children and adolescents with iron overload show more CVRFs, especially if they received replacement therapy with HD. Ferritin is related to CRP and IL-6 levels.

Recent studies considered that an increase in sympathetic activity (SA) may be responsible for left ventricular hypertrophy (LVH). Before and after renal transplantation (RT), we evaluated changes on left ventricular mass (LVM) and SA in 40 end-stage renal disease patients between 8 and 35 years old. Hypertension (95.0% vs. 71.0%; p=0.005), use of combined antihypertensive drugs (57.5% vs. 30.0%; p=0.01), and LVH (77.5% vs. 52.5%; p=0.01) significantly decreased after RT whereas low-to-high frequency ratio (LF/HF), which represents SA, increased (3.1 vs. 5.3; p=0.0001). However, LVM regressors (with decrease on LVM index more than 20%) showed a trend of lower change on LF/HF ratio (1.6 vs. 2.4; p= 0.09) than nonregressors. Living-donor graft, baseline LVM, use of antihypertensive drugs, lower change on LF/HF ratio, and lower systolic blood pressure levels were associated with LVM regression in the simple correlation analysis. However, in the logistic regression analysis, only baseline LVM and donor type remained in the model (R(2)=0.35; p=0.0003). Thus, LVH decreased after RT and was related to baseline LVM and living-donor type. However, it is possible that the higher persistence of LVH after RT could be explained at least in part by increase in heart sympathetic activity and use of immunosuppressors.