Intravenous Versus Oral Iron Supplementation for the Treatment of Anemia in CKD: Systematic Review and Meta-analysis

Rozen‐Zvi, Benaya; Gafter‐Gvili, Anat; Paul, Mical; Leibovici, Leonard; Shpilberg, Ofer; Gafter, Uzi

doi:10.1053/j.ajkd.2008.05.033

Cited by 145 publications

(135 citation statements)

References 35 publications

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“…This study is consistent with other studies that showed that in iron deficient hemodialysis patients randomized to oral iron or intravenous iron, only the group treated with intravenous iron had a significant increase in hemoglobin levels [9][10][11][12]. Intravenous iron preparations have very different molecular weights and side effect profiles [13], small proportions of patients given intravenous iron dextran develop a lifethreatening anaphylactic reaction, which is due to an immune-mediated reaction in patients who have dextran antibodies [14].…”

Section: Discussionsupporting

confidence: 90%

Intravenous Iron Is Effective and Safe in Correcting Anemia in Erythropoietin-Treated Hemodialysis Patients

et al. 2013

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Objectives: To study the effect of intravenous iron in the management of anemia in erythropoietin (EPO) treated hemodialysis patients with poor response to treatment with oral iron. Methods:Thirty-six patients (27 men and 9 women) with serum hemoglobin of less than 10 g/dl and a serum ferritin level of less than 500 mcg /l were included in the study. Each patient received 100 mg of intravenous iron at end of dialysis for 10 consecutive dialysis treatments, and once weekly of regular intravenous iron supplementation for another 13 weeks included in the study. All patients were receiving oral iron supplements (ferrous sulphate 325 mg twice daily), and were all also receiving EPO, a total dose of 8000 units per week, given subcutaneous as 4000 unit twice weekly throughout the study. The primary end point of this study was hemoglobin level at 4 months of starting intravenous iron supplementation. Results:The mean hemoglobin increased from 8.88 g/dl to11.18 g/dl over the period of the study (4 months) (p<0.0001). The mean serum ferritin increased from 179 mcg/l to 444 mcg/l over the same period (P<0.0001). Conclusion:Intravenous iron supplementation is very effective in correcting a poor response to EPO in hemodialysis patients on oral iron supplements.

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Section: Discussionsupporting

confidence: 90%

Intravenous Iron Is Effective and Safe in Correcting Anemia in Erythropoietin-Treated Hemodialysis Patients

et al. 2013

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“…previous studies have reported that patients undergoing hd showed a better response to iV iron; however, patients with crF showed no difference between oral and iV iron (9). another study demonstrated that iV and oral iron caused a similar correction in anemia over 6 weeks (17).…”

Section: Discussionmentioning

confidence: 86%

“…a recent systemic review and meta-analysis suggested that patients treated with iV iron have better hemoglobin (hb) levels than those treated with oral iron (9). however, some studies have found that oral iron is well tolerated and effective in long-term hd patients (10) and as effective as iV iron in pre-dialysis patients (11,12).…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of oral iron to manage anemia in long-term hemodialysis patients with the use of ultrapure dialysate

Tsuchida¹,

Paudyal²,

Paudyal

et al. 2010

Experimental and Therapeutic Medicine

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Abstract. the aim of this study was to evaluate the effectiveness of oral iron to manage anemia in long-term hemodialysis (hd) patients using ultrapure dialysate. this study was prospectively conducted on 23 patients (11 males and 12 females; median age 60 years, range 35-81) who underwent hd in our hospital from march to September 2007. the patients were randomly assigned to two treatment groups. The first group of 11 patients received ferrous fumarate 305 mg per oral tablet once a day, while the second group of 12 patients received infusions of 50 mg iron in a 0.9% sodium chloride solution. at the end of the 6-month treatment, patients receiving oral iron and intravenous iron had a significant increase in transferrin saturation from baseline (20.1±8.9 to 29.7±7.2; p=0.011 and 17.4±6.1 to 33.7±8.6; p=0.0001, respectively) and ferritin (32.6±15.4 to 115.4±28.2; p=0.0001 and 57.8±26.7 to 183.5±47.5; p=0.0002, respectively). in both groups, hemoglobin, hematocrit and dry weight were increased, but did not reach statistical significance. Moreover, both groups showed a significant reduction in the mean weekly erythropoietin dose from baseline (5,590.9±1,513.6 to 3,727.3±1,618.1; p=0.011 and 6,775.8±2,292.2 to 4,375.0±2,473.7; p=0.027, respectively). Oral iron is indeed as effective as intravenous iron in managing anemia in hd patients using ultrapure dialysate.

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“…iron can augment the response to erythropoietin therapy and significantly impact the dose requirements of erythropoietin in dialysis patients. The situation in nondialysis patients is less clear cut [36]. Many units, particularly in the early stages of CKD, try oral iron supplementation first, reserving i.v.…”

Section: Experience With IV Iron In Nephrologymentioning

confidence: 99%

Iron Supplementation in Nephrology and Oncology: What Do We Have in Common?

Macdougall

2011

The Oncologist

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Anemia is frequently seen in patients with chronic kidney disease and also in those with cancer. There are factors in the pathogenesis of anemia that are common to both clinical conditions, with iron insufficiency, inflammation, and upregulation of hepcidin activity playing a part in both chronic disease states. Diagnostic laboratory markers for detecting functional iron deficiency in renal disease and oncology are not ideal, and the most widely available tests, such as serum ferritin and transferrin saturation, have poor sensitivity and specificity. Other tests incorporating a surrogate for iron sufficiency in the RBC and reticulocyte (such as percentage hypochromic RBCs or reticulocyte hemoglobin content) have greater sensitivity/specificity, but unfortunately these tests are not widely available in many hospital laboratories. Iron supplementation may be given via the oral route, i.m., or i.v., but it is now clear that, in both the nephrology and oncology settings, i.v. iron is superior to oral iron in terms of efficacy. Oral iron is associated with a high incidence of gastrointestinal side effects, and although large epidemiological studies of i.v. iron are reassuring, the long-term safety of parenteral iron is not established in well-designed adequately powered randomized controlled trials. The Oncologist 2011;16(suppl 3):25-34

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Intravenous Versus Oral Iron Supplementation for the Treatment of Anemia in CKD: Systematic Review and Meta-analysis

Abstract: Our review shows that patients on hemodialysis therapy have better Hb level response when treated with IV iron. For patients with CKD, this effect is small.

Cited by 145 publications

References 35 publications

Intravenous Iron Is Effective and Safe in Correcting Anemia in Erythropoietin-Treated Hemodialysis Patients

Intravenous Iron Is Effective and Safe in Correcting Anemia in Erythropoietin-Treated Hemodialysis Patients

Effectiveness of oral iron to manage anemia in long-term hemodialysis patients with the use of ultrapure dialysate

Iron Supplementation in Nephrology and Oncology: What Do We Have in Common?

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