The included studies provide strong evidence for increased ferritin and transferrin saturation levels, together with a small increase in haemoglobin, in patients with CKD who were treated with IV iron compared with oral iron. From a limited body of evidence, we identified a significant reduction in ESA requirements in patients treated with IV iron, and found no significant difference in mortality. Adverse effects were reported in only 50% of included studies. We therefore suggest that further studies that focus on patient-centred outcomes are needed to determine if the use of IV iron is justified on the basis of reductions in ESA dose and cost, improvements in patient quality of life, and with few serious adverse effects.
[Iron supplementation during erythropoietin therapy in patients on hemodialysis].
The development of secondary anaemia is a constant associated phenomenon of chronic renal failure. During its treatment by recombinant human erythropoietin (rHuEPO) erythropoiesis is accelerated and this increases demands on the supply of dietary erythropoietic precursors (Fe, pyridoxine, folic acid, vitamin B12). In particular as regards iron, frequently the dietary amount is not sufficient and supplementation is necessary. The objective of the present work is to compare oral and intravenous iron supplementation in the treatment of secondary anaemia by rHuEPO in patients with chronic renal failure treated by haemodialysis. A group of haemodialyzed patients (n = 61) treated with erythropoietin, where the serum ferritin concentration had dropped beneath 300 ng/ml, or the transferrin concentration below 0.20 was divided at random into two sub-groups. To group "A" Actiferrin was administered 3 x 1 cps/d (Ferrosi sulfas heptahydricus, corresponding to 34.5 mg elemental Fe and serine 129 mg per capsule, i.e. a total of 724.5 mg elemental Fe per week). To group "A" Ferrum-Lek was administered 1 vial per week by the i.v. route (Ferri oxidum saccharatum, corresponding to 100 mg elemental iron per week). The two groups were comparable as to the mean erythropoietin dose (50 U/kg per week) and the patients' mean age (61 years), the male/female ratio and the spectrum of basic diseases. After six weeks of treatment a comparable increase of the haematocrit and serum iron concentration was observed in both groups. As to transferrin saturation, there was a more marked increment in the intravenously supplemented group. The serum ferritin values in group "A" declined, while in group "F" they increased. After both types of iron supplementation a comparable increase of the haematocrit and serum iron concentration occurred, the iron reserves represented by serum ferritin differed however and from the long-term aspect they are in favour of intravenous iron supplementation in haemodialyzed patients treated with erythropoietin.