Meta-analysis of the efficacy of intravenous iron supplementation versus oral iron supplementation on anemia in patients with non-dialysis-dependent chronic kidney disease

doi:10.3877/cma.j.issn.2095-3216.2019.02.004

Abstract

Abstract:

Objective

To evaluate the efficacy of intravenous iron supplementation versus oral iron supplementation on anemia in patients with non-dialysis-dependent chronic kidney disease (ND-CKD) by the method of systematic evaluation.

Methods

By computer and manual search until December 1, 2017, the EMBASE, PUBMED, and Cochrane Library were searched for all the randomized controlled trials (RCT) on the efficacy of intravenous iron supplementation or oral iron supplementation for anemia patients with ND-CKD. Statistical analyses were conducted with the RevMan Version 5 software for meta-analysis.

Results

A total of 11 foreign language RCT studies were included, totaling 1 707 patients, including 852 cases of intravenous iron supplementation and 855 cases of oral iron supplementation. The results of the analyses showed that the intravenous iron supplementation significantly increased the levels of hemoglobin (WMD 0.39 g/dl, 95%CI 0.26-0.52, P<0.0001), transferrin saturation (TSAT) (WMD 3.97%, 95%CI 2.24-5.7, P<0.0001), and ferritin (WMD, 244.51 ng/ml, 95%CI 185.51-303.52, P<0.0001), compared with oral iron supplementation. There was no significant difference in the incidence of adverse events between the two iron supplementation methods (RR 0.79, 95%CI 0.44-1.44, P=0.45).

Conclusion

The intravenous iron supplementation method was more effective in treating anemia patients with ND-CKD than the oral iron supplementation method.

Key words: Oral iron supplementation, Intravenous iron supplementation, Anemia, Non-dialysis-dependent chronic kidney disease, Meta-analysis

Xiaoyan Peng, Xiaoyuan Ning, Jiayun Xu. Meta-analysis of the efficacy of intravenous iron supplementation versus oral iron supplementation on anemia in patients with non-dialysis-dependent chronic kidney disease[J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2019, 08(02): 67-72.

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References 22

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研究名称	研究设计发表国家	静脉补铁(例)	口服补铁(例)	男性(%)		随访时间	血红蛋白(g/dl)/铁蛋白(ng/ml)/转铁蛋白饱和度(%)		铁剂量(mg)
研究名称	研究设计发表国家	静脉补铁(例)	口服补铁(例)	静脉补铁	口服补铁	随访时间	静脉补铁	口服补铁	静脉补铁	口服补铁
Stoves等(2011)^[11]	RCT英国	22	23	45.5	65.2	6 m	9.9^a/100^a/NR	9.7 /74.0^a/NR	300/m	200 tid
Aggarwal等(2003)^[6]	RCT印度	20	20	65.0	80.0	3 m	5.8/181.4/59.8	6.3/190.3/63.3	200/m	200 tid
Charytan等(2005)^[12]	RCT美国	48	48	39.6	29.2	43 d	9.8/125/16.6	9.7/103.0/15.6	1 000/w	325 tid
VanWyck等(2005)^[13]	RCT美国	79	82	32.9	31.7	56 d	10.2/92.6/16.4	10.1/103.8/16.7	200×5次/>2 w	325 tid
Agarwal等(2006)^[17]	RCT美国	36	39	44.4	38.5	70 d	10.5/72.5/17.2	10.7/66.4/17.9	250/w	325 tid
Pisani等(2015)^[18]	RCT意大利	33	66	30.0	27.0	3 m	10.7/67.7^a/7.0	10.8/71.4^a/16.5	125/w	30 qd
Qunibi等(2011)^[14]	RCT美国	147	103	36.1	29.1	56 d	10.1/111.8/15.4	10.0/104.8/15.8	1 000/w	325 tid
Nagaraju等(2013)^[15]	RCT加拿大	22	18	54.5	72.2	6 m	10.9 67 /16.5^a	11.1/71.0^a/17.0^a	200/m	11 tid
Macdougall等(2014)^[16]	RCT澳大利亚	153	308	40.5	37.7	12 m	10.3/57.7/16.2	10.4/57.3/15.5	500/w	100 bid
Agarwal等(2015)^[17]	RCT美国	67	69	74.6	78.3	24 m	10.7/173.0/174.0	10.5/133.0/17.3	200/>2 w	325 tid
Spinowitz等(2006)^[19]	RCT美国	228	76	41.2	31.6	35 d	9.96/146.1/11.3	9.96/143.5/10.1	1 020/w	200 qd

研究名称	研究设计发表国家	静脉补铁(例)	口服补铁(例)	男性(%)		随访时间	血红蛋白(g/dl)/铁蛋白(ng/ml)/转铁蛋白饱和度(%)		铁剂量(mg)
研究名称	研究设计发表国家	静脉补铁(例)	口服补铁(例)	静脉补铁	口服补铁	随访时间	静脉补铁	口服补铁	静脉补铁	口服补铁
Stoves等(2011)^[11]	RCT英国	22	23	45.5	65.2	6 m	9.9^a/100^a/NR	9.7 /74.0^a/NR	300/m	200 tid
Aggarwal等(2003)^[6]	RCT印度	20	20	65.0	80.0	3 m	5.8/181.4/59.8	6.3/190.3/63.3	200/m	200 tid
Charytan等(2005)^[12]	RCT美国	48	48	39.6	29.2	43 d	9.8/125/16.6	9.7/103.0/15.6	1 000/w	325 tid
VanWyck等(2005)^[13]	RCT美国	79	82	32.9	31.7	56 d	10.2/92.6/16.4	10.1/103.8/16.7	200×5次/>2 w	325 tid
Agarwal等(2006)^[17]	RCT美国	36	39	44.4	38.5	70 d	10.5/72.5/17.2	10.7/66.4/17.9	250/w	325 tid
Pisani等(2015)^[18]	RCT意大利	33	66	30.0	27.0	3 m	10.7/67.7^a/7.0	10.8/71.4^a/16.5	125/w	30 qd
Qunibi等(2011)^[14]	RCT美国	147	103	36.1	29.1	56 d	10.1/111.8/15.4	10.0/104.8/15.8	1 000/w	325 tid
Nagaraju等(2013)^[15]	RCT加拿大	22	18	54.5	72.2	6 m	10.9 67 /16.5^a	11.1/71.0^a/17.0^a	200/m	11 tid
Macdougall等(2014)^[16]	RCT澳大利亚	153	308	40.5	37.7	12 m	10.3/57.7/16.2	10.4/57.3/15.5	500/w	100 bid
Agarwal等(2015)^[17]	RCT美国	67	69	74.6	78.3	24 m	10.7/173.0/174.0	10.5/133.0/17.3	200/>2 w	325 tid
Spinowitz等(2006)^[19]	RCT美国	228	76	41.2	31.6	35 d	9.96/146.1/11.3	9.96/143.5/10.1	1 020/w	200 qd

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