Abstract
Introduction: Anemia is the most common finding in chronic kidney disease patients. Iron supplements are commonly prescribed for these patients with or without erythropoietin therapy by means of oral and intravenous iron. Both oral and intravenous irons have their own advantage and disadvantage, and the efficacy is also different. The objective of the study is to analyze the efficacy of oral and intravenous iron in chronic kidney disease patients on erythropoietin therapy, an erythropoiesis stimulating agents for increment of haemoglobin.
 Methods: This is a prospective study comparing intravenous iron to oral iron in chronic kidney disease patients who underwent maintenance hemodialysis at different centers and visited Kathmandu Medical College Teaching Hospital from April 2010 to April 2011. Patients having a haemoglobin level of < 11 g/dl, transferrin saturation (TSAT) < 25%, ferritin < 300ng/ml and who were on erythropoietin therapy were allocated alternately into two groups to receive oral iron (iron fumarate) or IV iron (iv sucrose). Haemoglobin was measured after 30 days of therapy.
 Results: A significant increase in haemoglobin levels was observed in both groups. But the mean haemoglobin increment was more in the IV iron group than in the oral iron group. Sixty percent 60% of patients in the IV iron group had an increase in the haemoglobin level of more than 1gm/dl while only 20% of the oral iron group had this increase.
 Conclusions: Intravenous iron therapy is more effective in raising the hemoglobin level in hemodialysis dependent chronic kidney disease patients.
 Keywords: anemia; chronic kidney disease; iron.
Highlights
Anemia is the most common finding in chronic kidney disease patients
Intravenous iron therapy is more effective in raising the hemoglobin level in hemodialysis dependent chronic kidney disease patients
Sixty percent of the patients in the IV iron group had an increase in the haemoglobin level of more than 1gm/dL while only 24.4% patients in oral iron group had the same level of increase which is statistically significant (p value < 0.05) (Table 3)
Summary
Iron supplements are commonly prescribed for these patients with or without erythropoietin therapy by means of oral and intravenous iron. The objective of the study is to analyze the efficacy of oral and intravenous iron in chronic kidney disease patients on erythropoietin therapy, an erythropoiesis stimulating agents for increment of haemoglobin. Iron therapy in dialysis dependent chronic kidney disease (HD-CKD) patients serves as an adjuvant to erythropoiesis-stimulating. In patients with non-dialysis dependent CKD (ND-CKD), only a third of patients receive ESA therapy.[3] Three routes of administration for iron are available: oral, intramuscular, and intravenous.[4] iron deficiency is the most common cause of resistance to erythropoietin therapy, contributing to ineffective erythropoiesis and hematocrit/haemoglobin values below the recommended target range of 11 g/dL-12 g/dL (33% - 36%). Iron supplementation improves iron indices and haemoglobin concentration, and reduces the required ESA dose.[5,6,7,8,9,10,11,12]
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