Abstract
After relative erythropoietin deficiency, iron deficiency is the second most important contributing factor for anemia in chronic kidney disease (CKD) patients. Iron supplementation is a crucial part of the treatment of anemia in CKD patients, and intravenous (IV) iron supplementation is considered to be superior to per os (PO) iron supplementation. The differences between the available formulations are poorly characterized. This report presents results from pairwise and network meta-analyses carried out after a comprehensive search in sources of published and unpublished studies, according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) recommendations (International prospective register of systematic reviews PROSPERO reference ID: CRD42020148155). Meta-analytic calculations were performed for the outcome of non-response to iron supplementation (i.e., hemoglobin (Hgb) increase of <0.5–1.0 g/dL, or initiation/intensification of erythropoiesis-stimulating agent (ESA) therapy, or increase/change of iron supplement, or requirements of blood transfusion). A total of 34 randomized controlled trials (RCT) were identified, providing numerical data for analyses covering 93.7% (n = 10.097) of the total study population. At the network level, iron supplementation seems to have a more protective effect against the outcome of non-response before the start of dialysis than once dialysis is initiated, and some preparations seem to be more potent (e.g., ferumoxytol, ferric carboxymaltose), compared to the rest of iron supplements assessed (surface under the cumulative ranking area (SUCRA) > 0.8). This study provides parameters for adequately following-up patients requiring iron supplementation, by presenting the most performing preparations, and, indirectly, by making it possible to identify good responders among all patients treated with these medicines.
Highlights
IntroductionIron deficiency is the second most common contributing factor for anemia in chronic kidney disease (CKD) patients [1,2]
After relative erythropoietin deficiency, iron deficiency is the second most common contributing factor for anemia in chronic kidney disease (CKD) patients [1,2]
The standardized flowchart produced by the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) group [5] is presented in Figure 1, showing the study selection process that led to the inclusion of 34 randomized controlled trials (RCT)
Summary
Iron deficiency is the second most common contributing factor for anemia in chronic kidney disease (CKD) patients [1,2]. Anemia may be considered a surrogate marker of CKD severity, and its treatment may slow down the progression of concomitant heart disease and cardiovascular disease, as well as the evolution of CKD towards end-stage kidney disease (ESKD) [3]. The effects and benefits of different IV iron supplements compared to per os (PO) iron supplements are still poorly characterized in the different stages of CKD: an accurate description of the impact of different iron supplementation formulations may improve physicians’ decision-making process and promote an individualized treatment approach to iron-deficiency anemia (IDA) in CKD patients. Our study aim was to assess treatment response to different commercially available iron supplements in CKD patients, which was defined by the increase in the hemoglobin (Hgb) level and/or the need for erythropoiesis-stimulating agent (ESA) therapy and other treatments of anemia in CKD patients
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