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Anemia is one of the most common complications of chronic kidney disease (CKD) and is associated with other complications like increased hospitalization and the requirement of blood transfusion, decreased quality of life, etc. Despite of standard care with adequate dialysis, many patients continue to be anemic and it also affects their peri-operative outcomes during and after renal transplantation. Literature review shows that Lactoferrin is useful in treating anemia in pregnant woman and patients with malignancy. No data on efficacy of Lactoferrin in adults having CKD with anemia is available. Our study objective was to compare efficacy of Lactoferrin with standard care Vs. standard care alone in improvement of anemia. CTRI number of the project is CTRI/2020/04/024746.
CKD patients with anemia, undergoing dialysis were screened at the outdoor patient service. CKD patients with stable creatinine for 3 months, Hb< 10 g/dL, stable erythropoietin dose, no new addition of hematinics in last 3 months were enrolled. Patients with hematological malignancy, HBV, HCV, HIV, hematological kidney disease, clinically significant bleed, infection at presentation, receiving systemic immunosuppressive therapy, and were pregnant/lactating during study were excluded from study. They were then randomised into two groups; those receiving treatment of Lactoferrin (100mg twice daily) with standard care (Lac arm) and those receiving standard care alone (control group). Clinical data of enrolled patients was recorded and blood samples of patients were collected at baseline and 3 months follow-up. Statistical analysis was done using General Linear Model.
Lactoferrin with standard care treatment performs better in the treatment of anemia with CKD with anemia patients than standard care alone. Effect of Lactoferrin on inflammatory markers, however, was not statistically significant. This indicates that Lactoferrin improves anemia irrespective of its effect of inflammatory markers of ESR and CRP. The possible etiology may be increased iron uptake and utilization. Studies with larger cohort and long term follow-up are warranted.