# A cost-effective innovation in anaemia management for paediatric patients with haemodialysis-dependent chronic kidney disease

## TL;DR

This study shows that ferric carboxymaltose is a safe, effective, and cost-saving alternative to iron sucrose for treating anemia in children on home hemodialysis.

## Contribution

The study demonstrates the viability of ferric carboxymaltose in pediatric hemodialysis patients, with fewer infusions and significant cost savings.

## Key findings

- Ferric carboxymaltose significantly improved and maintained key blood parameters like hemoglobin and transferrin saturation.
- It required about ten times fewer infusions per month compared to iron sucrose.
- The treatment led to a fivefold cost reduction in IV iron therapy.

## Abstract

Paediatric patients undergoing haemodialysis typically require intravenous (IV) iron therapy to replenish iron stores. Upon establishing our home haemodialysis service, the need for an efficient IV iron administration method prompted exploration beyond the conventional use of iron sucrose, which is associated with anaphylaxis and requires frequent infusions. Ferric carboxymaltose has a favourable safety profile and corrects iron deficiency with less frequent infusions. We aimed to establish if ferric carboxymaltose was a viable alternative in this patient group.

This single-centre, uncontrolled retrospective cohort study assessed the effectiveness of ferric carboxymaltose in maintaining laboratory parameters (haemoglobin level, transferrin saturation and reticulocyte haemoglobin content) within target range in our home haemodialysis population. Secondly, we conducted a comparative analysis to establish maintenance efficacy of ferric carboxymaltose, versus iron sucrose over a 12-month period. Finally, we performed a cost-effectiveness analysis of IV iron therapy, considering cost per dose and per month of treatment.

Following ferric carboxymaltose infusion, we observed significant increases in haemoglobin level, transferrin saturation and reticulocyte haemoglobin content, which was maintained at 3-month post-infusion. Ferric carboxymaltose demonstrated comparable efficacy to iron sucrose in maintaining laboratory parameters. Strikingly, ferric carboxymaltose treatment was associated with significantly decreased number of infusions per month (~ tenfold) and a significant cost-saving (~ fivefold).

This study underscores the clinical efficacy and economic benefits of ferric carboxymaltose as a viable treatment for iron deficiency anaemia in paediatric patients who are haemodialysis-dependent and highlights the potential for significant improvements in healthcare delivery, in terms of reducing frequency of hospital visits for this patient population.

A higher resolution version of the Graphical abstract is available as
Supplementary information

A higher resolution version of the Graphical abstract is available as
Supplementary information

The online version contains supplementary material available at 10.1007/s00467-025-06680-x.