Comment: The quality of evidence is downgraded by study limitations (unclear sequence generation and allocation concealment) and by inconsistency (unexplained variability in results).
A Cochrane review [Abstract] 1 included 39 studies with a total of 3852 subjects. IV iron compared with oral iron may increased the number of participants who achieved target haemoglobin (table T1), increased haemoglobin (MD 0.72 g/dL, 95% CI 0.39 to 1.05; 31 studies, n=3373), ferritin (MD 224.8μg/L, 95% CI 165.85 to 283.83; 33 studies, n=3389), and transferrin saturation (MD 7.69%, 95% CI 5.10 to 10.28; 27 studies, n=3089). There was a significant reduction in erythropoiesis-stimulating agent (ESA) dose in patients receiving dialysis who were treated with IV iron. Heterogeneity among studies remained largely unexplained, but was likely to be related to the significant variation in the relative doses of IV and oral iron used in each study. Mortality and cardiovascular mortalitydid not differ significantly (table T1). Gastrointestinal side effects were more common with oral iron, but hypotensive and allergic reactions were more common with IV iron.
| Outcome | Relative effect (95% CI) | Risk with oral iron | Risk with IV iron (95% CI) | No. of participants (studies) |
|---|---|---|---|---|
| Death (all causes) | RR 1.12 (0.64 to 1.94) | 30 per 1000 | 33 per 1000 (19 to 58) | 1952 (11) |
| Cardiovascular death | RR 1.71 (0.41 to 7.18) | 20 per 1000 | 34 per 1000 (8 to 142) | 206 (3) |
| Type of adverse event: allergic reactions/hypotension | RR 3.56 (1.88 to 6.74) | 7 per 1000 | 24 per 1000 (13 to 46) | 2607 (15) |
| Number achieving target Hb or increase ≥1 g/dL | RR 1.71 (1.43 to 2.04) | 317 per 1000 | 542 per 1000 (453 to 646) | 2206 (13) |
| Number requiring transfusion | RR 0.86 (0.55 to 1.34) | 101 per 1000 | 87 per 1000 (56 to 136) | 774 (5) |
Date of latest search: 2019-05-09
Primary/Secondary Keywords