Egypt: Researchers have found in a new study that among children with chronic kidney disease and iron deficiency anemia, iron polymaltose complex (IPC) produced a superior hematologic response, with greater improvements in hemoglobin and transferrin saturation compared with liposomal iron. However, liposomal iron was better tolerated, showing fewer adverse effects, highlighting a trade-off between efficacy and tolerability.Iron deficiency anemia is common in pediatric chronic kidney disease (CKD) and is associated with fatigue, poor growth, and reduced quality of life. Oral iron therapy is widely used, but gastrointestinal intolerance often limits adherence. Newer formulations such as liposomal iron have been developed to improve tolerability, though comparative evidence in children with CKD has been limited.To compare these two oral iron options, Happy Sawires from Cairo University, Egypt, and colleagues conducted a crossover study published in Pediatric Nephrology. The study enrolled 33 children with CKD and iron deficiency anemia, who were randomized into two groups. One group received liposomal iron for three months, while the other received IPC for the same duration. After an eight-week washout period, participants crossed over to the alternate therapy.Red blood cell indices and iron parameters were measured at baseline and after each treatment phase. Bone mineral markers and vitamin D levels were also assessed, and adverse events were recorded during follow-up visits. The study led to the following findings:Both liposomal iron and iron polymaltose complex (IPC) effectively improved iron status in children with chronic kidney disease and iron deficiency anemia.An increase in hemoglobin of at least 1 g/dL was observed in 48% of children treated with liposomal iron and 51.5% of those receiving IPC.Direct comparisons showed no significant differences between the two treatments in changes in hemoglobin or other iron indices.Mixed-model analysis indicated that IPC was associated with higher hemoglobin levels, greater transferrin saturation, and a lower soluble transferrin receptor response, suggesting a stronger hematologic effect.IPC therapy was linked to a significant reduction in serum phosphorus levels, an effect not seen with liposomal iron.The potential impact of IPC on mineral metabolism could not be fully assessed, as parathyroid hormone and fibroblast growth factor 23 levels were not measured.Tolerability differed notably between treatments, with adverse effects reported in 36% of IPC recipients compared with only 3% of children receiving liposomal iron.Overall, liposomal iron demonstrated a more favorable safety and tolerability profile than IPC.The authors acknowledged limitations, including the small sample size, short treatment duration, and lack of blinding, which may restrict the generalizability of the findings. However, as the first cross-over study comparing novel oral iron formulations in pediatric CKD, the trial provides important preliminary insights.”Overall, the study suggests that while IPC may deliver greater hematologic benefits in children with CKD and iron deficiency anemia, liposomal iron offers improved tolerability. Larger, longer-term studies are needed to better define the optimal oral iron strategy for this vulnerable population,” the authors concluded. Reference:Sawires, H., Abd Alazem, E.A., Atia, F. et al. Oral liposomal iron vs. oral iron polymaltose in children with chronic kidney disease iron deficiency anemia: a cross-over study. Pediatr Nephrol (2026). https://doi.org/10.1007/s00467-025-07138-w