Introduction: Iron overload is a well-known complication in chronic kidney disease (CKD) patients, especially on regular hemodialysis, where that can lead to harm to different organs, necessitating the search for an optimal evaluation method. This work was to screen the iron status in pediatric patients with CKD5d, assessing the degree of iron overload by biochemical iron profile and non-invasive quantitative magnetic resonance imaging (MRI) spectrometry to the liver and heart. 
Methods: This analytical cross-sectional study was conducted on pediatric CKD patients on regular hemodialysis (HD) (CKD5d), at Pediatric Dialysis and Nephrology Unit, Children's Hospital, Ain Shams University. All patients were subjected to detailed history including the frequency of iron and blood transfusion, investigations including iron profile [serum iron, total iron binding capacity, and serum ferritin (SF)], and myocardial and hepatic iron status using quantitative MRI imaging R2* of liver iron (LIC), and myocardial iron content (MIC). 
Results: Our study included 23 pediatric CKD5d patients with a mean (±SD) age and dialysis duration of 13.83 (± 1.90), and 6.83 (± 2.81) years, respectively. Blood transfusion was given to 4 patients (17.4%) more than 5 times during the whole dialysis duration, 17 patients (73.9%) less than 5 times, while 2 patients (8.7%) had never been transfused. All our patients received intravenous iron, in addition to Erythropoietin. Eighteen patients had iron overload, where 7 patients (30.4%) had SF between 500 -1000 ng/mL, & 11 patients (47.8%) had SF >1000 ng/mL while 5 patients (21.7%) had SF < 500 ng/mL. LIC revealed that 13 (56.5%) CKD5d patients had mild liver iron overload, 2 (8.7%) had moderate liver iron overload, and 4 (17.4%) had severe liver iron overload. Cardiac iron overload was less frequent (one patient, 4.3%). LIC had correlated positively with the age of the patients, serum iron, SF, and TSAT (r=0.483, 0.748, 0.829, 0.78 and p-value 0.020, <0.001, <0.001, <0.001 respectively).
Conclusions: Iron overload is a common problem in CKD5d pediatric patients, blood transfusions should be restricted, and iron supplementation should be taken very cautiously in anemic CKD patients.