The aim of this study is to evaluate the effects of adding lactoferrin to the every-other-day oral iron supplementation in iron deficiency anemia and chronic kidney disease patients.

1. Ethical committee approval has been obtained from Ethics committee of Faculty of Medicine, Alexandria University.

2. All participants should agree to take part in this clinical study and will provide informed consent.

3. Sixty chronic kidney disease patients with iron defficiency anemia,will be recruited from the Kidney and Urology Center (KUC) and Alexandria main university hospital (AMUH).

   The 60 participants will be randomly assigned into 2 arms.

   Control arm (n=30): will be treated with oral ferrous glycine sulfate (100mg) every other day for 3 months

   Intervention arm (n=40): will be treated with oral lactoferrin (one sachet that contains 100mg) with oral ferrous glycine sulfate (100mg) every other day for 3 months.

4. All patients will be subjected directly at time of enrollment to the following; Complete history taking and demographic data (age, sex, …)

5. Blood samples will be drawn to measure the initial values of hemoglobin, hematocrit, serum iron, TIBC, Serum Transferrin Saturation (TSAT), and Hepcidin as primary outcome.

6. All patients will be followed up and treated during the study time. All relevant routine investigations and medications will be recorded.

7. At each visit, the subjects will be questioned about study compliance (diet and medications), concomitant medications, and adverse events.

8. The results obtained from the work will be tabulated and statistically analyzed using the appropriate statistical methods.

9. The findings will be discussed in view of the achievement of the aim, their significance and their comparison with other available works and information.

Inclusion Criteria:

1. Males and Females aged ≥ 18 years old
2. Patients with eGFR ≥30 and ≤60 mL/min/1.73m2.
3. Absolute iron deficiency anemia (Hgb <10g/dL, serum ferritin <300ng/ml and Transferrin Saturation < 30% )

Exclusion Criteria:

1. Patients on intermittent hemodialysis (IHD)
2. Patients with any known cause of anemia other than iron deficiency or CKD (e.g., sickle cell anemia)
3. Patients who received EPO 4 weeks ago
4. Patients who received IV Iron 8 weeks ago
5. Patients who received blood Transfusion 8 weeks ago
6. Current history of GI bleeding
7. Malignancy history
8. Pregnancy or lactation in female participants
9. Patients non-adherent to at least 80% of the regimen

open labeled