الفهرس 
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Abstract
Anemia, a major complication of CKD, is associated with reduced quality of life, increased risk of cardiovascular disease, hospitalizations, cognitive impairment, and mortality. Regulation of erythropoiesis is one of the functions of IL-6, which has been implicated in anemia. The effects of IL-6 on erythropoiesis likely include iron-mediated and iron-independent actions. IL-6 is the major upstream activator of hepcidin, a hepatic iron-regulatory hormone, in anemia of inflammation. Hepcidin is a hormone that binds to ferroportin on the cell wall and diminishes expression of iron transport protein transferrin and induces erythropoietin resistance, so it inhibits intestinal absorption and mobilization of iron stores. LF has very high affinity to iron. The more efficient iron absorption from LF than that from iron salts might be due to the presence of specific LF receptors on human mucosa cells, which generate a receptor-mechanism pathway. LF acts as a transcriptional modulator of the inflammatory process through the inhibition of pro-inflammatory cytokines. Sixty patients with ESRD on regular HD and 30 healthy children of matched age and sex serving as a control group were included in the study. The patients were divided to into 2 groups, one group received lactoferrin supplementation and the other group received lactoferrin and oral iron supplementation for 3 months. Routine laboratory investigation and specific research investigations including serum ferritin, TSAT, serum hepcidin and serum interleukin 6 before and after the supplementation. Patients were then subdivided according to the results into 15, 45 patients having absolute iron deficiency and functional iron deficiency respectively. Aim of this work was to evaluate the effect of lactoferrin administration on serum iron status of children on regular hemodialysis. Hemoglobin level significantly decreased at the end of the study in patient who had absolute iron deficiency and received lactoferrin supplementation only but significantly increased in those with functional iron deficiency and received lactoferrin and oral iron supplementation. In patients with functional iron deficiency, serum ferritin significantly decreased after supplementation but TSAT significantly increased in patients received lactoferrin and oral iron supplementation. In patient with absolute iron deficiency, serum ferritin and TSAT significantly decreased in patients received lactoferrin only but no significant difference in patients received lactoferrin and oral iron supplementation at the end of the study. In our study, serum hepcidin and serum interleukin 6 were higher in patients than controls at the start of the study but significantly decreased at the end of the study in patients. Serum hepcidin and serum interleukin 6 were significantly higher in patients had functional iron deficiency than those had absolute iron deficiency. There was positive correlation between serum hepcidin and serum interleukin 6. There was a positive correlation between serum hepcidin and both CRP and ferritin but a negative correlation between hepcidin and both Hb and TSAT. There was a positive correlation between serum IL-6 and both CRP and ferritin but a negative correlation between IL-6 and both Hb and TSAT.