Intravenous Versus Oral Iron for Treatment of Iron Deficiency in Non-hemodialysis-dependent Patients With Chronic Kidney Disease

Anne Marie Liles


Am J Health Syst Pharm. 2012;69(14):1206-1211. 

In This Article

Oral Versus I.V. Iron in Patients Not Receiving ESAs

A study conducted by Agarwal et al.[21] is the only published trial to compare i.v. and oral iron solely in ND-CKD patients not receiving an ESA. Seventy-five patients were randomized to receive oral ferrous sulfate 325 mg three times daily for six weeks (n = 39) or i.v. sodium ferric gluconate 250 mg weekly for four doses (n = 36). Baseline data were similar between groups and below the KDOQI's recommended goals for hemoglobin, TSAT, and ferritin values. The mean change in hemoglobin concentration from baseline did not significantly differ between treatment groups (0.4 ± 0.8 g/dL versus 0.2 ± 0.9 g/dL for the i.v. and oral iron groups, respectively). The mean change in TSAT level from baseline significantly differed between the i.v. and oral iron groups (mean increase of 8.3% ± 7.5% versus 2.9% ± 8.8%, respectively; p = 0.007). Similarly, increases in ferritin concentrations significantly differed between the i.v. and oral iron groups (mean increase of 232.0 ± 160.8 ng/mL versus 55.9 ± 236.2 ng/mL, p < 0.001). The increases in TSAT and ferritin values in both groups were also noteworthy when compared with their respective baseline values. A greater number of patients in the i.v. iron group experienced adverse effects (29.5% versus 20% in the oral iron group). Constipation was most frequent in the oral iron group, and hypotension and nausea were the most frequent adverse effects in the i.v. iron group. Three of the adverse events in the i.v. iron group were classified as serious. The authors concluded that oral and i.v. iron resulted in similar increases in hemoglobin concentrations in iron-deficient ND-CKD patients not receiving an ESA.


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