Comparative Study of Oral vs. Intravenous Iron Supplements in the Management of Anemia in Chronic Kidney Disease
DOI:
https://doi.org/10.52783/jns.v14.3247Keywords:
Chronic kidney disease, anemia, iron supplementation, intravenous iron, oral iron therapyAbstract
Aim: The study aimed to compare the efficacy, safety, and tolerability of oral and intravenous (IV) iron supplementation in the management of anemia in chronic kidney disease (CKD) patients.
Materials and Methods: This prospective, randomized, comparative clinical trial was conducted at a tertiary care hospital, enrolling 120 adult patients with CKD-associated anemia. Patients were randomly assigned to either the oral iron group (n=60), receiving ferrous sulfate 200 mg twice daily for 12 weeks, or the IV iron group (n=60), receiving IV iron sucrose 200 mg weekly for five doses. Hemoglobin (Hb), serum ferritin, and transferrin saturation (TSAT) levels were measured at baseline, week 4, week 8, and week 12. Adverse events, including gastrointestinal symptoms in the oral group and infusion reactions in the IV group, were recorded. Statistical analysis was performed using SPSS, with a significance level of p < 0.05.
Results: At week 12, the IV iron group showed a significantly greater increase in Hb (11.35 ± 0.93 g/dL) compared to the oral iron group (10.75 ± 0.95 g/dL, p < 0.001). Ferritin levels also increased more in the IV iron group (480.75 ± 80.40 ng/mL vs. 225.40 ± 55.25 ng/mL, p < 0.001), along with TSAT (38.90 ± 6.50% vs. 24.50 ± 5.40%, p < 0.001). Gastrointestinal side effects were reported in 16 (26.67%) patients in the oral iron group, while infusion reactions were observed in 9 (15.00%) patients receiving IV iron (p < 0.001). Multiple regression analysis identified IV iron therapy as the strongest predictor of hemoglobin improvement (β = 0.40, p < 0.001), while diabetes mellitus negatively impacted hemoglobin response (β = -0.12, p = 0.038).
Conclusion: IV iron supplementation was more effective than oral iron in improving hemoglobin levels, ferritin, and TSAT in CKD patients with anemia. While oral iron was associated with gastrointestinal side effects, IV iron therapy had a higher incidence of infusion-related reactions. Given its superior efficacy, IV iron should be the preferred treatment for patients requiring rapid and effective anemia correction, particularly in moderate to severe CKD cases.
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Rozen-Zvi B, Gafter U, Chagnac A, et al. Intravenous iron supplementation in erythropoietin-treated anemic patients with chronic kidney disease: a randomized controlled trial. Clin J Am Soc Nephrol. 2008;3(3):653-8.
Van Wyck DB, Roppolo M, Martinez CO, Mazey RM, McMurray S. A randomized, controlled trial comparing IV iron sucrose to oral iron in anemic patients with non-dialysis-dependent CKD. Kidney Int. 2005;68(6):2846-56.
Charytan C, Bernardo MV, Koch TA, Butcher A, Morris D, Bregman DB. Intravenous ferric carboxymaltose versus standard medical care in patients with iron deficiency anemia and CKD: a randomized, controlled trial. Nephrol Dial Transplant. 2013;28(4):953-64.
Khalafallah AA, Dennis AE. Iron deficiency anemia in pregnancy and postpartum: pathophysiology and effect of oral versus intravenous iron therapy. J Pregnancy. 2012;2012:630519.
Anker SD, Comin Colet J, Filippatos G, et al. Ferric carboxymaltose in patients with heart failure and iron deficiency. N Engl J Med. 2009;361(25):2436-48.
Bhandari S, Kalra PA, Kothari J, et al. A randomized, open-label trial of iron isomaltoside 1000 (Monofer) compared with iron sucrose (Venofer) as maintenance therapy in haemodialysis patients. Nephrol Dial Transplant. 2015;30(9):1577-89.
St Peter WL, Obrador GT, Roberts TL, Collins AJ. Trends in intravenous iron use among dialysis patients in the United States (1994-2002). Am J Kidney Dis. 2005;46(4):650-60.
Macdougall IC, Bock AH, Carrera F, Eckardt KU, Gaillard C, Van Wyck D, et al. FIND-CKD: A randomized trial of intravenous ferric carboxymaltose versus oral iron in patients with chronic kidney disease and iron deficiency anemia. Nephrol Dial Transplant. 2014;29(11):2075-84.
Fishbane S, Mathew AT, Vaziri ND. Iron toxicity: relevance for dialysis patients. Nephrol Dial Transplant. 2017;32(2):248-53.
Macdougall IC, White C, Anker SD, Bhandari S, Farrington K, Kalra PA, et al. Intravenous iron in patients undergoing maintenance hemodialysis. N Engl J Med. 2019;380(5):447-58.
Malyszko J, Tesarova P, Macdougall IC, Wolff F, Evenepoel P. Iron metabolism and iron supplementation in chronic kidney disease patients. Hemodial Int. 2018;22(S1):S65-72.
Qunibi WY, Martinez C, Smith M, Benjamin J. A randomized controlled trial comparing intravenous ferric gluconate to oral iron for treatment of iron deficiency anemia in patients with chronic kidney disease. Clin Nephrol. 2011;75(6):440-9.
Coyne DW, Kapoian T, Suki W, Singh AK, Moran JE, Dahl NV, et al. Ferric gluconate is highly efficacious in patients with high serum ferritin and low transferrin saturation. Kidney Int. 2020;57(5):2093-101.
Ishida JH, Johansen KL. Iron and anemia in chronic kidney disease: new insights into optimal management strategies. Curr Opin Nephrol Hypertens. 2019;28(6):505-11.
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