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• W2017325841 abstract "Dr Agarwal1.Agarwal R. Is i.v. iron really superior in CKD patients not on dialysis.Kidney int. 2006Abstract Full Text Full Text PDF Scopus (1) Google Scholarraises a number of important questions. The answer to the title question would seem to be yes, i.v. iron is superior to oral iron. Moreover, the degree of difference is clinically significant: in chronic kidney disease patients with anemia (hemoglobin (Hb) <11 g/dl) without erythropoiesis-stimulating agents (ESA) or without an increase in ESA dose, i.v. iron administration will raise the Hb higher, stimulate a Hb increase >1.0 g/dl more often, achieve or exceed the target Hb threshold of ≥11.0 g/dl more consistently, and replete iron stores more reliably than oral iron therapy. The answer to whether we should have included patients with ESA dose increases in the analysis of efficacy is no. Increasing ESA doses, like starting ESA anew, administering additional i.v. iron off protocol, or transfusing the patient, introduces a co-intervention. The penalty for including co-interventions is the inability to isolate iron treatment effects. As we discussed, previous randomized controlled trials that failed to preclude co-interventions failed to show between-group differences in patients assigned to i.v. iron or oral iron treatment.2.Stoves J. Inglis H. Newstead C.G. A randomized study of oral vs. intravenous iron supplementation in patients with progressive renal insufficiency treated with erythropoietin.Nephrol Dial Transplant. 2001; 16: 967-974Crossref PubMed Scopus (83) Google Scholar,3.Charytan C. Qunibi W. Bailie G.R. Comparison of intravenous iron sucrose to oral iron in the treatment of anemic patients with chronic kidney disease not on dialysis.Nephron Clin Pract. 2005; 100: c55-c62Crossref PubMed Scopus (96) Google Scholar Was the duration of the trial sufficient to show efficacy? We demonstrated that the peak Hb response in both treatment groups occurred before 42 days, well before completion of the 56-day observation period. Among patients assigned to oral iron, peak increase in Hb was lower than in i.v.-treated patients, as we showed, but time to peak increase did not differ between groups (Cox proportional hazards model: 36.1 vs 39.9 days, oral vs i.v.; P=0.3481). Logistic regression analysis yielded only baseline ferritin <100 ng/ml as a significant covariate in increasing the odds of a positive Hb response, a result we explored in more detail in the analyses we presented in Table 2. Was the duration of the trial sufficient to conclude that i.v. iron, compared to oral iron, is safe in patients with chronic kidney disease? Three randomized controlled trials, including ours, have examined the effect of i.v. iron administration compared to oral iron therapy on renal function in chronic kidney disease patients. In the first, patients given i.v. iron sucrose 300 mg monthly up to 6 months showed a rate of decline of renal function no different from that seen in patients given oral iron.2.Stoves J. Inglis H. Newstead C.G. A randomized study of oral vs. intravenous iron supplementation in patients with progressive renal insufficiency treated with erythropoietin.Nephrol Dial Transplant. 2001; 16: 967-974Crossref PubMed Scopus (83) Google ScholarIn the second, patients assigned to oral iron therapy showed a significant decline in ClCr, whereas their counterparts given i.v. iron dextran 100 mg twice monthly up to 3 months showed no decline.4.Aggarwal H.K. Nand N. Singh S. et al.Comparison of oral versus intravenous iron therapy in predialysis patients of chronic renal failure receiving recombinant human erythropoietin.J Assoc Physicians India. 2003; 51: 170-174PubMed Google ScholarOur results in patients who received five 200 mg doses or two 500 mg doses of iron sucrose showed a slower rate of decline of glomerular filtration rate in patients treated with i.v. iron compared to those assigned to oral iron therapy. Taken together, the evidence suggests that i.v. iron is at least as safe as oral iron in preserving glomerular filtration rate in anemic chronic kidney disease patients. We, as others,2.Stoves J. Inglis H. Newstead C.G. A randomized study of oral vs. intravenous iron supplementation in patients with progressive renal insufficiency treated with erythropoietin.Nephrol Dial Transplant. 2001; 16: 967-974Crossref PubMed Scopus (83) Google Scholarfound no effect of either i.v. iron or oral iron on C-reactive protein." @default.
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• W2017325841 date "2006-09-01" @default.
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• W2017325841 title "Response to Is i.v. iron really superior in CKD patients not on dialysis?" @default.
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• W2017325841 doi "https://doi.org/10.1038/sj.ki.5001529" @default.
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