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, mortality and other patient important outcomes were seldom reported.

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 included 28 studies with a total of 2098 subjects. Haemoglobin (MD 0.90 g/dL, 95% CI 0.44 to 1.37; 22 trials, n=1862; heterogeneity I²=95%); and in the subgroups of dialysis patients (MD 1.16 g/dL, 95% CI 0.30 to 2.02; 13 trials, n=828), ferritin (MD 243.25 μg/L, 95% CI 188.74 to 297.75; 24 trials, n=1751; I²=92%); and transferrin saturation (MD 10.20%, 95% CI 5.56 to 14.83; 18 trials, n=1457; I²=96%) were significantly increased by IV iron compared with oral iron. There was a significant reduction in erythropoiesis-stimulating agent (ESA) dose in patients receiving dialysis who were treated with IV iron (SMD -0.76, 95% CI -1.22 to -0.30; 9 trials, n= 487; I²=81%). 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 (5 trials) and cardiovascular mortality (2 trials) did not differ significantly, but were reported in very few studies. Gastrointestinal side effects were more common with oral iron, but hypotensive and allergic reactions were more common with IV iron.

Clinical comments

Date of latest search: 28 March 2010

Ədəbiyyat

1. Albaramki J, Hodson EM, Craig JC et al. Parenteral versus oral iron therapy for adults and children with chronic kidney disease. Cochrane Database Syst Rev 2012;1:CD007857.