Iron Polymaltose Complex Outperforms Liposomal Iron in Pediatric CKD Anemia

New research suggests iron polymaltose complex (IPC) demonstrated a superior hematologic response compared with liposomal iron in pediatric patients with chronic kidney disease (CKD) and iron deficiency anemia (IDA).1

Although both oral iron formulations effectively improved iron status, investigators observed discernible differences in efficacy and tolerability, with liposomal iron demonstrating a more favorable tolerability profile.1

Iron deficiency anemia (IDA) is a leading complication in children with chronic kidney disease (CKD), including early disease stages.1

Liposomal iron has been shown to increase hemoglobin and iron indices with improved tolerability in pediatric and adult CKD populations. IPC is widely used in children with IDA and is generally well tolerated. However, data evaluating its use in pediatric CKD, particularly in direct comparison with liposomal iron, are limited.1,2,3

“This is the first crossover study comparing novel oral iron preparations for the treatment of IDA in children with CKD,” wrote study investigator Happy Sawires, MD, professor of medicine at Cairo University, and colleagues.1

Sawires and colleagues conducted a 2-period crossover study to compare iron polymaltose complex (IPC) and liposomal iron in pediatric patients with CKD and IDA. 1

They randomized patients into 2 groups, A and B, to receive either 240 mg liposomal iron at a dose of 1.4 mg/kg/day administered once daily or IPC at a dose of 6 mg/kg for 3 months. After an 8-week washout period, they were switched to the other therapy.1

At baseline and after each 3-month treatment period, investigators assessed red cell indices, iron parameters, bone minerals, and 25-hydroxyvitamin D3. A follow-up visit at 4 weeks during each treatment period was conducted to assess adverse events.1

Anemia was defined as hemoglobin below the lower limit of normal for age and IDA was diagnosed when transferrin saturation <20% and serum ferritin < 100 ng/ml]. The CKD diagnostic criteria were based on the guidelines proposed by Kidney Disease: Improving Global Outcomes (KDIGO).1

The primary outcome was efficacy after 3 months, assessed by percentage change in Hb (ΔHb), serum iron (ΔFe), TSAT (ΔTSAT), and sTR (ΔsTR). Secondary outcomes focused on safety, including treatment-related adverse events.1

The study included 33 pediatric patients aged 1 to 15 years with CKD stages 2 to 5 who were not receiving kidney replacement therapy and were treated at the Pediatric Nephrology Outpatient Clinic at Cairo University Children’s Hospital.1

Investigators observed an increase in hemoglobin levels by < 1 g/dL in 16 patients (48%) after liposomal iron treatment and in 17 patients (51.5%) following IPC therapy. Serum ferritin levels increased significantly after IPC and liposomal iron administration in group B (P <.001 and P = .003, respectively), whereas in group A, a significant increase was observed only with liposomal iron (P <.001).1

In group A, investigators did not discover any statistically significant differences between liposomal iron and IPC in ΔHb, ΔFe, ΔsTR, or ΔTSAT (P = .534, .401, .80, and .955, respectively). Similarly, in group B, no significant differences were observed for these parameters (P = .298, .20, .102, and .786, respectively).1

In mixed-model analysis, investigators observed IPC was associated with significantly increased Hb and TSAT and lower sTR levels compared with liposomal iron (P ≈ .039, .023, and .044, respectively), while changes in serum iron were not significantly different. No significant period or carryover effects were observed.1

Investigators noted IPC exhibited a substantial reduction in serum phosphorus levels in both groups A and B (P = .043 and .044, respectively), while there was a non-significant decrease in both serum calcium and 25(OH)D3 levels (P > .05). Notably, liposomal iron did not induce any significant changes in these parameters.1

In general, adverse effects were mild and more prevalent with IPC compared to liposomal iron. Specifically, 12 (36%) of IPC recipients experienced adverse effects, whereas only 3 (9%) of liposomal iron recipients experienced adverse effects. This difference was statistically significant (P < .001).1

“In conclusion, both IPC and liposomal iron effectively improved iron status in children with CKD and IDA,” investigators concluded. However, IPC indicated a superior response as evidenced by higher Hb and TSAT and lower sTR compared with liposomal iron, whereas liposomal iron was associated with a more favorable tolerability profile.”1

They noted future studies comparing both formulations with ferrous sulfate may further clarify their relative efficacy.1

References

1. Sawires H, Abd Alazem EA, Atia F, Salem A, Samy A, Gamal M. Oral liposomal iron vs. oral iron polymaltose in children with chronic kidney disease iron deficiency anemia: a cross-over study. Pediatric Nephrology. Published online January 15, 2026. doi:https://doi.org/10.1007/s00467-025-07138-w

2. Rangaraj S, Suresh P, Sundar S, Raju P. Liposomal Iron vs. Conventional Iron in the Treatment of Iron Deficiency Anemia in Children: A Randomized Controlled Trial. Cureus. Published online November 18, 2025. doi:https://doi.org/10.7759/cureus.97183

3. Mohd Rosli RR, Norhayati MN, Ismail SB. Effectiveness of iron polymaltose complex in treatment and prevention of iron deficiency anemia in children: a systematic review and meta-analysis. PeerJ. 2021;9:e10527. doi:https://doi.org/10.7717/peerj.10527