WCN26-6583 Oral lactoferrin in anemia of chronic kidney disease: A systematic review and meta-analysis

Introduction: Anemia is a prevalent and multifactorial complication of chronic kidney disease (CKD), often driven by inflammation, impaired iron metabolism, and reduced erythropoietin production. Lactoferrin, an iron-binding glycoprotein with immunomodulatory and antimi crobial properties, has demonstrated efficacy in improving iron indices in general iron deficiency anemia. However, its role in CKD-associated anemia remains inadequately characterized. Methods: A systematic review and meta-analysis were conducted to evaluate the effectiveness of oral lactoferrin compared to standard-of care therapies—including iron supplementation and/or erythropoiesis stimulating agents—for the treatment of anemia in adult and pediatric CKD patients. PubMed, Embase, and Cochrane CENTRAL were searched through May 7, 2025. Data were pooled using a random-ef fects model, and heterogeneity was assessed using the I2 statistic. Sensitivity analyses and trial sequential analysis (TSA) were performed to assess robustness and adequacy of cumulative evidence. Results: Four studies comprising 413 participants were included in the final analysis. Lactoferrin supplementation was associated with a statistically significant increase in transferrin saturation (MD: 8.12%; 95% CI: [0.61, 15.63]; p = 0.03), while improvements in hemoglobin (MD: 0.66 g/dL; 95% CI: [-0.06, 1.38]; p = 0.07) and serum iron (MD: 19.20 mcg/dL; 95% CI: [-4.56, 42.96]; p = 0.11) did not reach statistical significance. Conclusion: Oral lactoferrin supplementation was associated with a significant improvement in transferrin saturation and a non-significant trend toward higher hemoglobin and serum iron levels in CKD-related anemia. While these findings suggest a potential role in improving functional iron availability, further well-designed trials are needed to confirm its clinical utility.