Anemia, or a lack of red blood cells and oxygen, is a common condition resulting from chronic kidney disease (CKD). In treatment, could a more direct intravenous (IV) method of iron delivery hold any advantages over taking pills?

A recent update to a study first published in 2012 investigated the potential benefits of IV versus oral administration of iron to treat anemia in adults and children with CKD.*   The results, published in the Cochrane Database of Systematic Reviews, were inconclusive.

What they did

A team led by Emma O’Lone at the Sydney School of Public Health examined the results of 39 randomized control trials (RCTs) and quasi-RCTs through December 2018, totaling 3,852 participants. The researchers looked at studies comparing IV and oral iron delivery methods for treating concurrent anemia in adults and children with CKD.

What they found

• The results showed some evidence that, compared to pills, IV administration of iron treatment is better at increasing blood levels of iron and iron-carrying components, such as hemoglobin, in people with CKD.
• They also found the potential for fewer side effects common with oral iron, including constipation and stomach upset.
• There was, however, a greater potential for allergic reaction to IV.
• There was insufficient evidence to determine whether IV iron versus oral iron treatment is more beneficial for reducing death (specifically cardiovascular death) and improving the quality of life in people with CKD.

Conclusion

It remains in question whether IV iron is justified as a way to reduce the dose and cost of erythropoietin (hormone) stimulators for red blood cell production, to improve patient quality of life, and to reduce deaths, compared to its “small risk of potentially serious allergic effects.” The authors suggested that additional studies with longer follow-up periods are needed.

*O’Lone, E.L.; Hodson, E.M.; Nistor, I.; et al. (2019, Feb. 21). “Parental versus oral iron therapy for adults and children with chronic kidney disease.” Cochrane Database of Systematic Reviews.