American Journal of Kidney Diseases
Volume 52, Issue 5 , Pages 897-906, November 2008

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

  • Benaya Rozen-Zvi, MD

      Affiliations

    • Department of Nephrology and Hypertension, Tel Aviv University, Tel-Aviv, Israel
    • Corresponding Author InformationAddress correspondence to Benaya Rozen-Zvi, MD, Department of Nephrology, and Hypertension, Rabin Medical Center, Beilinson Hospital, 49100, Petah-Tikva, Israel
  • ,
  • Anat Gafter-Gvili, MD

      Affiliations

    • Department of Hematology, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
  • ,
  • Mical Paul, MD

      Affiliations

    • Infectious Disease Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
  • ,
  • Leonard Leibovici, MD

      Affiliations

    • Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, and the Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
  • ,
  • Ofer Shpilberg, MD

      Affiliations

    • Department of Hematology, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
  • ,
  • Uzi Gafter, MD, PhD

      Affiliations

    • Department of Nephrology and Hypertension, Tel Aviv University, Tel-Aviv, Israel

Received 31 January 2008; accepted 21 May 2008. published online 09 October 2008.

Background

Iron supplementation is essential for the treatment of patients with anemia of chronic kidney disease (CKD). It is not clear which is the best method of iron administration.

Study Design

Systematic review and meta-analysis. A search was performed until January 2008 of MEDLINE, Cochrane Central Register of Controlled Trials, conference proceedings in nephrology, and reference lists of included trials.

Setting & Population

Patients with CKD (stages III to V). We included dialysis patients and patients with CKD not on dialysis therapy (hereafter referred to as patients with CKD).

Selection Criteria for Studies

We included all randomized controlled trials regardless of publication status or language.

Intervention

Intravenous (IV) versus oral iron supplementation.

Outcomes Measures

Primary outcomes assessed: absolute hemoglobin (Hb) level or change in Hb level from baseline. We also assessed all-cause mortality, erythropoiesis-stimulating agent requirement, adverse events, ferritin level, and need for renal replacement therapy in patients with CKD.

Results

13 trials were identified, 6 including patients with CKD and 7 including dialysis patients. Compared with oral iron, there was a significantly greater Hb level in dialysis patients treated with IV iron (weighted mean difference, 0.83 g/dL; 95% confidence interval, 0.09 to 1.57). Meta-regression showed a positive association between Hb level increase and IV iron dose administered and a negative association with baseline Hb level. For patients with CKD, there was a small but significant difference in Hb level favoring the IV iron group (weighted mean difference, 0. 31 g/dL; 95% confidence interval, 0.09 to 0. 53). Data for all-cause mortality were sparse, and there was no difference in adverse events between the IV- and oral-treated patients.

Limitations

There was significant heterogeneity between trials. Follow-up was limited to 2 to 3 months.

Conclusions

Our review shows that patients on hemodialysis therapy have better Hb level response when treated with IV iron. For patients with CKD, this effect is small.

Index Words: Anemia, iron, chronic kidney disease, hemodialysis, hemoglobin, meta-analysis

To access this article, please choose from the options below

Login to an existing account or Register a new account.

  • Purchase this article for 30.00 USD (You must login/register to purchase this article)

    Online access for 24 hours. The PDF version can be downloaded as your permanent record.

  • Subscribe to this title

    Get unlimited online access to this article and all other articles in this title 24/7 for one year.

  • Claim access now

    For current subscribers with Society Membership or Account Number.

  • Visit SciVerse ScienceDirect to see if you have access via your institution.
 

 B.R.Z and A.G.-G. contributed equally to this work.

 Originally published online as doi:10.1053/j.ajkd.2008.05.033 on October 9, 2008.

PII: S0272-6386(08)01060-3

doi:10.1053/j.ajkd.2008.05.033

American Journal of Kidney Diseases
Volume 52, Issue 5 , Pages 897-906, November 2008