{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T15:48:37Z","timestamp":1791820117477,"version":"4.3.4"},"reference-count":29,"publisher":"Ovid Technologies (Wolters Kluwer Health)","funder":[{"name":"Indian Council of Medical Research","award":["project ID 2020-9417"],"award-info":[{"award-number":["project ID 2020-9417"]}],"id":[{"id":"https:\/\/ror.org\/0492wrx28","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["CJASN"],"abstract":"\n Key Points<\/jats:title>\n \n \n \n Lactoferrin+iron significantly improved hemoglobin and iron indices versus iron alone in CKD patients with iron deficiency anemia.<\/jats:p>\n <\/jats:list-item>\n \n Lactoferrin reduced hepcidin and inflammatory markers, suggesting improved iron utilization using anti-inflammatory mechanisms.<\/jats:p>\n <\/jats:list-item>\n \n Three patients with iron deficiency anemia had elevated inflammatory markers, higher among patients with CKD on dialysis than those not on dialysis.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>\n \n Background<\/jats:title>\n Lactoferrin, a multifunctional iron-binding glycoprotein with anti-inflammatory properties, is reported to be effective in anemia in pregnant women and patients with malignancy but has not been tested elaborately in CKD.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n In this randomized, open-label trial, 185 patients (intention-to-treat) with iron-deficiency anemia (hemoglobin [Hb] <10 g\/dl, transferrin saturation <20%) were enrolled: 90 with patients with CKD not on dialysis (CKD-ND) and 95 with dialysis-dependent CKD (patients with CKD on dialysis [CKD-5D]). Patients were randomized to receive either oral iron (30 mg\/d liposomal iron) or oral iron+lactoferrin (100 mg twice daily) for 3 months. The primary outcome was change in Hb. Secondary outcomes included iron indices and inflammatory markers (C-reactive protein, IL-6, erythrocyte sedimentation rate, and hepcidin).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n In the intention-to-treat analysis, lactoferrin+iron resulted in significantly greater improvements in Hb and iron parameters than iron alone in both patients with CKD-ND and those with CKD-5D. Mean Hb increased by 1.95\u00b11.19 versus 1.33\u00b10.86 g\/dl in patients with CKD-ND and by 1.73\u00b10.96 versus 1.11\u00b10.93 g\/dl in patients with CKD-5D receiving lactoferrin+iron and iron alone, respectively. Improvements in iron indices were also greater with add-on lactoferrin treatment. Mean difference in hepcidin levels were \u221220.24\u00b115.99 versus \u221216.03\u00b140.65 ng\/dl in patients with CKD-ND and \u221215.29\u00b18.73 versus \u221220.99\u00b120.16 ng\/dl in patients with CKD-5D treated with lactoferrin+iron and iron alone, respectively.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Among patients with CKD-associated anemia, adjunctive lactoferrin therapy improved Hb and iron parameters compared with oral iron alone in both non\u2013dialysis-dependent and dialysis-dependent patients. Lactoferrin was also associated with modest improvements in inflammatory status, although effects on individual inflammatory markers were inconsistent. These findings suggest that lactoferrin may be a useful adjunct to oral iron therapy for the management of anemia in CKD, especially in resource-limited settings.<\/jats:p>\n <\/jats:sec>\n \n Clinical Trial registry name and registration number:<\/jats:title>\n Clinical Trials Registry of India, CTRI\/2020\/04\/024746.<\/jats:p>\n <\/jats:sec>","DOI":"10.2215\/cjn.0000001204","type":"journal-article","created":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T16:00:21Z","timestamp":1788364821000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Randomized Controlled Trial Comparing Lactoferrin+Iron with Iron Alone for Iron Deficiency Anemia in CKD"],"prefix":"10.2215","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3960-6133","authenticated-orcid":false,"given":"Smita","family":"Divyaveer","sequence":"first","affiliation":[{"name":"Post Graduate Institute of Medical Education and Research, Chandigarh, 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