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

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• 作者：Daniel Shepshelovich ; MD¹ ; ² ; ^&lowast ; ; ^{shepshelovich@yahoo.com" class="auth_mail" title="E-mail the corresponding author} ; Benaya Rozen-Zvi ; MD² ; ³ ; ^&lowast ; ; Tomer Avni ; MD² ; ⁴ ; Uzi Gafter ; MD ; PHD² ; ³ ; Anat Gafter-Gvili ; MD¹ ; ² ; ⁵
• 关键词：Iron ; anemia ; IV iron ; oral iron ; iron supplementation ; chronic kidney disease (CKD) ; dialysis ; end-stage renal disease (ESRD) ; haemoglobin ; Hb response ; transferrin saturation (TSAT) ; ferritin ; erythropoiesis-stimulating agent (ESA) ; blood transfusion ; quality of life ; safety ; ferric carboxymaltose ; ferumoxytol ; isomaltoside ; iron sucrose ; iron dextran ; ferric gluconate ; cideferron ; systematic review
• 刊名：American Journal of Kidney Diseases
• 出版年：2016
• 出版时间：November 2016
• 年：2016
• 卷：68
• 期：5
• 页码：677-690
• 全文大小：1953 K

文摘

Iron supplementation is crucial for the treatment of anemia of chronic kidney disease (CKD). Although intravenous (IV) iron is preferred for patients with CKD receiving dialysis (CKD stage 5D), the method of iron replacement for patients with CKD stages 3 to 5 is controversial.

Study Design

Systematic review and meta-analysis. A search was performed until October 2015 of MEDLINE, Cochrane Library, conference proceedings in nephrology, and reference lists of included trials.

Setting & Population

Patients with CKD stages 3 to 5 or 5D.

Selection Criteria for Studies

All randomized controlled trials, regardless of publication status or language.

Intervention

IV versus oral iron supplementation.

Outcomes

The primary outcome was defined as percentage of patients reaching an elevation in hemoglobin (Hb) concentration > 1 g/dL. Secondary end points included percentage of patients who reached Hb levels > 11 g/dL, absolute Hb concentration, change in Hb concentration, transferrin saturation, ferritin levels, erythropoiesis-stimulating agents and blood transfusion requirement, and quality of life. Safety analysis included all-cause mortality and serious and all adverse events.

Results

24 trials were identified, 13 including 2,369 patients with CKD stages 3 to 5 and 11 including 818 patients with CKD stage 5D. Patients treated with IV iron were more likely to reach an Hb response > 1 g/dL (risk ratios [RRs] of 1.61 [95% CI, 1.39-1.87] for CKD stages 3-5 and 2.14 [95% CI, 1.68-2.72] for CKD stage 5D). Safety analysis showed similar rates of mortality and serious and any adverse effects. IV iron replacement was associated with higher risk for hypotension (RR, 3.71; 95% CI, 1.74-7.94) and fewer gastrointestinal adverse events (RR, 0.43; 95% CI, 0.28-0.67).

Limitations

Significant heterogeneity between trials; follow-up was usually limited to 3 months.

Conclusions

Our results agree with current recommendations for IV iron replacement for patients with CKD stage 5D and support increased use of IV iron for patients with CKD stages 3 to 5.