Parenteral versus oral iron therapy for adults and children with chronic kidney disease

O’Lone, Emma; Hodson, Elisabeth M; Nistor, Ionuţ; Bolignano, Davide; Webster, Angela C; Craig, Jonathan C.

doi:10.1002/14651858.cd007857.pub3

Cited by 41 publications

(44 citation statements)

References 88 publications

(4 reference statements)

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“…Iron deficiency is the top-ranking cause of anemia worldwide and intravenous (IV) iron has been shown to be superior to oral iron in achieving a sustained hematological response in patients with iron deficiency anemia (IDA) of various etiologies, including inflammatory bowel disease, chronic heart failure, chronic kidney disease and hemodialysis, heavy uterine bleeding, pregnancy, and when administered in the perioperative period as a part of a patient blood management strategy [1][2][3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Indirect methods of comparison of the safety of ferric derisomaltose, iron sucrose and ferric carboxymaltose in the treatment of iron deficiency anemia

Pollock

Biggar

2020

Expert Review of Hematology

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Objectives: The benefits of intravenous (IV) iron greatly outweigh the risks, but IV iron formulations carry a small risk of hypersensitivity reactions (HSRs). The objective was to use standardized Medical Dictionary for Regulatory Activities queries (SMQs) to compare the safety of ferric derisomaltose/iron isomaltoside 1000 (FDI), iron sucrose (IS), and ferric carboxymaltose (FCM) using prospective trial data. Methods: Prospective trials reporting the incidence of SMQ-coded serious or severe HSRs were identified in the literature. Four SMQs were used: narrow hypersensitivity terms (A), and broad terms pertaining to potential respiratory HSRs (B), skin HSRs (C), and cardiovascular HSRs (D). Bayesian inference, naïve pooling, and adjusted indirect approaches were employed to compare HSR incidence. Results: Twenty one prospective trials including over 8,000 patients receiving FDI, FCM or IS were retrieved. Odds ratios of any serious or severe HSR (all groups) with FDI relative to FCM were 0.41, 0.39, and 0.45 according to the Bayesian, naïve and adjusted approaches, respectively. Conclusions: The risk of serious or severe HSRs was lower with FDI relative to FCM and IS. Using data from prospective trials including over 8,000 patients coded using a well-defined standard (SMQs) enabled a robust comparison of HSR incidence between the iron formulations.

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Section: Introductionmentioning

confidence: 99%

Indirect methods of comparison of the safety of ferric derisomaltose, iron sucrose and ferric carboxymaltose in the treatment of iron deficiency anemia

Pollock

Biggar

2020

Expert Review of Hematology

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“…Similarly, in a study with sequential assessment of iron profiles, compared with those who had normal Hb at 1 year, the subgroup with persistent anemia showed a greater decline in iron stores as reflected by lower values of serum ferritin 22 . In multiple comparative studies of intravenous and oral iron in patients with non‐dialysis CKD, a similar faster rate of iron repletion, and improved anemia control have been reported 23‐27 . Unlike the adverse cardiovascular and mortality outcomes reported for CKD, correction of anemia by targeting higher Hb range [12.5‐13.5 g/dL] in the transplant population has been demonstrated to attenuate allograft dysfunction while decreasing the mortality rate 28,29 …”

Section: Discussionmentioning

confidence: 97%

“…22 In multiple comparative studies of intravenous and oral iron in patients with non-dialysis CKD, a similar faster rate of iron repletion, and improved anemia control have been reported. [23][24][25][26][27] Unlike the adverse cardiovascular and mortality outcomes reported for CKD, correction of anemia by targeting higher Hb range [12.5-13.5 g/dL] in the transplant population has been demonstrated to attenuate allograft dysfunction while decreasing the mortality rate. 28,29 TA B L E 3 Prevalence of anemia at different time points of renal transplantation among subjects immediately treated with iron infusion after surgery compared with the historical controls The benefit of intravenous iron treatment may be more pronounced in populations (such as ours) with a greater prevalence and/ or severity of iron deficiency.…”

Section: Clinical Outcome Associated With Post-surgery Use Of Intramentioning

confidence: 99%

“…A Cochrane systematic review also showed a superior performance of intravenous iron over oral therapy by enhancing iron repletion while reducing the incidence of ESA requirement. 27 Lower events of blood transfusion reduced the risk of HLA sensitization and therefore provided a greater prospect for successful future retransplantation. 31 Furthermore, intravenous iron use was associated with better preservation of GFR at 12 and 24 months.…”

Section: Primary Renal Pathologymentioning

confidence: 99%

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Impact of immediate post‐transplant parenteral iron therapy on the prevalence of anemia and short‐term allograft function in a cohort of pediatric and adolescent renal transplant recipients

Iorember

Avilés

Bamgbola

2020

Pediatric Transplantation

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The prevalence of anemia after a recent KTX surgery in adults ranges from 70% to 90%, while the incidence of late-onset anemia is 20%-50%. 1-3 Similarly, in a few available pediatric studies, the prevalence of anemia was reported as 84% in the first month of transplant and 25%-50% at 12 months. 4-6 Unfortunately, due to a widespread under-diagnosis of post-transplant anemia (PTA), inadequate treatment is a frequent phenomenon. 1,7 However, early-and late-onset PTAs have been associated with a high all-cause mortality rate and shorter duration of allograft survival. 2,6,8-11 Due to a high turnover rate of iron during chronic dialysis and because of peri-surgical blood loss, ID is the major cause of early-onset anemia. 7,12-14 On the other hand, late-onset anemia (>12 month post-transplant) is principally driven by inadequate nutrition and EPO deficiency that results from impaired allograft function. 3,15,16

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“…3 However, there are some patient cohorts who may benefit from intravenous iron without a trial of oral therapy. They include patients who have heart failure with a reduced ejection fraction, 15 those undergoing haemodialysis, 17 and pregnant women in their second or third trimester requiring rapid iron replenishment. 18…”

Section: Is Parenteral Iron Indicated?mentioning

confidence: 99%

A stain on iron therapy

Canning¹,

Grannell²

2020

Aust Prescr

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Iron staining is an unwanted and in some cases permanent adverse effect of intravenous iron administration. Cosmetically unacceptable staining may cause distress and have psychological implications for the patient. There should be a suitable indication for parenteral iron therapy. Patients must be advised of the risk of harm and give their informed consent before receiving parenteral iron. Strategies to minimise the risks of staining with intravenous iron include appropriate cannulation and close monitoring of the infusion. Stop the infusion if there are signs of extravasation. Laser therapy may be a treatment option in cases of persistent discolouration due to iron staining. is limited in practice, 3 but the injection can be given into an unexposed site. However, administration at an unexposed site is not necessarily possible when giving iron intravenously. A rise in reports of iron staining 6-10 may correspond with the increasing use of intravenous iron in clinical practice. 6-13 Minimising harm Specific definitive risk factors for extravasation of intravenous iron have not been published. The principles for minimising the harm associated with intravenous iron preparations have been adapted from those applied to intramuscular iron (Box 1). 5 They include a good infusion technique (Box 2). REFERENCES SELF-TEST QUESTIONS True or false? 1. Extravasation of intravenous iron leads to skin necrosis 2. The skin staining from intravenous iron usually resolves in one week

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Parenteral versus oral iron therapy for adults and children with chronic kidney disease

Abstract: Parenteral versus oral iron therapy for adults and children with chronic kidney disease.

Cited by 41 publications

References 88 publications

Indirect methods of comparison of the safety of ferric derisomaltose, iron sucrose and ferric carboxymaltose in the treatment of iron deficiency anemia

Indirect methods of comparison of the safety of ferric derisomaltose, iron sucrose and ferric carboxymaltose in the treatment of iron deficiency anemia

Impact of immediate post‐transplant parenteral iron therapy on the prevalence of anemia and short‐term allograft function in a cohort of pediatric and adolescent renal transplant recipients

A stain on iron therapy

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