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Evidence summaries

Parenteral Versus Oral Iron Therapy for Adults and Children with Chronic Kidney Disease

Parenteral iron therapy may be effective for increasing haemoglobin, ferritin and transferrin saturation in chronic kidney disease compared to oral iron. However, it may not decrease mortality and other patient important outcomes. Level of evidence: "C"

Comment: The quality of evidence is downgraded by study limitations (unclear sequence generation and allocation concealment) and by inconsistency (unexplained variability in results).

Summary

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.

Oral versus IV iron in adults and children with chronic kidney disease

OutcomeRelative effect (95% CI)Risk with oral ironRisk with IV iron (95% CI)No. of participants (studies)
Death (all causes)RR 1.12 (0.64 to 1.94)30 per 100033 per 1000 (19 to 58)1952 (11)
Cardiovascular deathRR 1.71 (0.41 to 7.18)20 per 100034 per 1000 (8 to 142)206 (3)
Type of adverse event: allergic reactions/hypotensionRR 3.56 (1.88 to 6.74)7 per 100024 per 1000 (13 to 46)2607 (15)
Number achieving target Hb or increase HASH(0x2f82cc8)1 g/dLRR 1.71 (1.43 to 2.04)317 per 1000542 per 1000 (453 to 646)2206 (13)
Number requiring transfusionRR 0.86 (0.55 to 1.34)101 per 100087 per 1000 (56 to 136)774 (5)

Clinical comments

Note

Date of latest search: 2019-05-09

References

  • O'Lone EL, Hodson EM, Nistor I et al. Parenteral versus oral iron therapy for adults and children with chronic kidney disease. Cochrane Database Syst Rev 2019;(2):CD007857.[PubMed]

Primary/Secondary Keywords