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Iron treatment for adults and children with reduced kidney function

Albaramki J, Hodson EM, Craig JC, Webster AC
Published Online: 
18 January 2012

Anaemia often occurs in people who have kidney damage, especially those who need dialysis treatment. Anaemia can cause tiredness, reduce exercise tolerance and increase heart size. A common cause of anaemia is reduced production of a hormone, erythropoietin. Iron deficiency can make anaemia worse, and reduce response to drugs that stimulate erythropoietin production. Iron can be taken orally (by mouth) or injected intravenously (via a vein). Intravenous (IV) iron is given under supervision in hospitals. There is uncertainty about whether IV iron should be used rather than oral iron. In this review of 28 studies (2098 participants), IV iron resulted in higher levels of haemoglobin (a measure of anaemia) and blood iron levels compared with oral iron, and a reduction in the amount of erythropoietin required for people receiving dialysis. IV iron resulted in a small number of allergic reactions not seen with oral iron, but oral iron caused more vomiting, nausea, constipation and diarrhoea than IV iron. No differences were found in other outcomes (deaths from any cause, deaths due to heart disease, quality of life) but these were reported in few (9/28) studies. No studies investigated the impact on patients who did not need dialysis of coming to hospital to receive IV iron. Although the results confirm that IV iron is more effective in raising iron and haemoglobin levels compared with oral iron, we found insufficient data to determine if the benefits of IV iron are justified by improved quality of life (fewer gastric upsets) despite the small risk of potentially serious allergic effects in some patients given IV iron.

This record should be cited as: 
Albaramki J, Hodson EM, Craig JC, Webster AC. Parenteral versus oral iron therapy for adults and children with chronic kidney disease. Cochrane Database of Systematic Reviews 2012, Issue 1. Art. No.: CD007857. DOI: 10.1002/14651858.CD007857.pub2
Assessed as up to date: 
28 March 2010