Efficacy of IV Iron Compared to Oral Iron for Increment of Haemoglobin Level in Anemic Chronic Kidney Disease Patients

Abstract

Introduction: Anemia is the most common finding in chronic kidney disease patients. Iron supplements are commonly prescribed for these patients with or without erythropoietin therapy by means of oral and intravenous iron. Both oral and intravenous irons have their own advantage and disadvantage, and the efficacy is also different. The objective of the study is to analyze the efficacy of oral and intravenous iron in chronic kidney disease patients on erythropoietin therapy, an erythropoiesis stimulating agents for increment of haemoglobin.
 Methods: This is a prospective study comparing intravenous iron to oral iron in chronic kidney disease patients who underwent maintenance hemodialysis at different centers and visited Kathmandu Medical College Teaching Hospital from April 2010 to April 2011. Patients having a haemoglobin level of < 11 g/dl, transferrin saturation (TSAT) < 25%, ferritin < 300ng/ml and who were on erythropoietin therapy were allocated alternately into two groups to receive oral iron (iron fumarate) or IV iron (iv sucrose). Haemoglobin was measured after 30 days of therapy.
 Results: A significant increase in haemoglobin levels was observed in both groups. But the mean haemoglobin increment was more in the IV iron group than in the oral iron group. Sixty percent 60% of patients in the IV iron group had an increase in the haemoglobin level of more than 1gm/dl while only 20% of the oral iron group had this increase.
 Conclusions: Intravenous iron therapy is more effective in raising the hemoglobin level in hemodialysis dependent chronic kidney disease patients.
 Keywords: anemia; chronic kidney disease; iron.

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

“…11 g/ dL. 29,39 There was no statistically significant difference between patients treated with IV iron and oral iron preparations (RR, 1.65; 95% CI, 0.54-5.05).…”

“…[29][30][31][32][33][34][36][37][38][39] Hb concentration change from baseline was increased in the IV arm (mean difference, 0.33 [95% CI, 20.11 to 0.76] g/dL; 3 trials; 319 patients). 34, 35,37 Two trials including 164 patients reported the number of patients who reached Hb levels .…”

“…1 g/dL following iron replacement. 29,36,39 The RR for Hb response . 1 g/dL with IV iron compared to oral iron was 2.14 (95% CI, 1.68-2.72), with a number needed to treat of 3 (95% CI, 2-4), for a baseline percentage of 30% (Fig 4).…”

“…[17][18][19]21 Three trials that included patients with CKD stage 5D were of low risk of allocation generation bias, 30,34,37 7 were of unclear risk, 29,31-33,35,36,38 and 1 was of high risk. 39 All included studies were unblinded. All trials were considered as low risk for incomplete outcome data (attrition bias) and only 1 trial 28 was considered as high risk for selective outcome reporting (reporting bias).…”

“…18,19,21 Seven trials of patients with CKD stage 5D were of low risk of sequence generation bias, 30-34,36,37 3 were of unclear risk, 29,35,38 and 1 was of high risk. 39 Regarding allocation generation, 9 trials of patients with CKD stages 3 to 5 were of low risk of bias, 16,20,22-28 whereas 4 were of unclear risk. [17][18][19]21 Three trials that included patients with CKD stage 5D were of low risk of allocation generation bias, 30,34,37 7 were of unclear risk, 29,31-33,35,36,38 and 1 was of high risk.…”