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Intravenous iron and erythropoiesis-stimulating agents in haemodialysis: A systematic review and meta-analysis

Authors
 SIMON D ROGER  ;  MARTIN TIO  ;  HYEONG-CHEON PARK  ;  HUI LIN CHOONG  ;  BAKLEONG GOH  ;  TIMOTHY ROBERT CUSHWAY  ;  VANESSA STEVENS  ;  IAIN C MACDOUGALL 
Citation
 NEPHROLOGY, Vol.22(12) : 969-976, 2017 
Journal Title
 NEPHROLOGY 
ISSN
 1320-5358 
Issue Date
2017
Keywords
ESA ; chronic kidney disease ; epoetin ; haemodialysis ; intravenous iron ; meta-analysis
Abstract
AIM: Higher dosages of erythropoiesis-stimulating agents (ESAs) have been associated with adverse effects. Intravenous iron is used to optimize ESA response and reduces ESA doses in haemodialysis patients; this meta-analysis evaluates the magnitude of this effect. METHODS: A literature search was performed using MEDLINE, Embase and the Cochrane Collaboration Central Register of Clinical Trials from inception until December 2014, to identify randomized controlled trials of intravenous iron and ESA, in patients undergoing haemodialysis for end-stage kidney disease. Dosing of IV iron in concordance with the Kidney Disease Improving Global Outcomes guidelines was considered optimal iron therapy. RESULTS: Of the 28 randomized controlled trials identified, seven met the criteria for inclusion in the meta-analysis. Results of random-effects meta-analysis show a statistically significant weighted mean (95% CI) difference of -1733 [-3073, -392] units/week in ESA dose for optimal iron versus suboptimal iron. The weighted average change in ESA dose was a reduction of 23% (range -7% to -55%) attributable to appropriate dosing of intravenous iron. A comparison of intravenous iron versus oral iron/no iron (five trials) showed a greater reduction in ESA dose, although this did not reach statistical significance (weighted mean difference, 95% CI: -2,433 [-5183, 318] units/week). The weighted average change in ESA dose across the five trials was a reduction of 31% (range -8% to -55%). CONCLUSION: Significant reductions in ESA dosing may be achieved with optimal intravenous iron usage in the haemodialysis population, and suboptimal iron use may require higher ESA dosing to manage anaemia.
Files in This Item:
T999901353.pdf Download
DOI
10.1111/nep.12940
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Park, Hyeong Cheon(박형천) ORCID logo https://orcid.org/0000-0002-1550-0812
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/165935
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