Cochrane · systematic review · CD007857
Parenteral versus oral iron therapy for adults and children with chronic kidney disease
O'Lone, EL, Hodson, EM, Nistor, I, et al. · Cochrane Database of Systematic Reviews · 2019 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
14
current version
GRADE rated
14
No studies
0
Included studies
NR
No studies 0 · 0%Ungraded 0 · 0%Very low 2 · 14.3%Low 12 · 85.7%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Current version onlyPatient‐centred outcomes for oral versus IV iron in adults and children with chronic kidney disease
Population: adults and children with CKD
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Death (all causes) Patient‐centred outcomes for oral vs IV iron | RR 1.12 [0.64, 1.94] | 11 studies · 1952 participants | Low Downgraded: imprecision |
Cardiovascular death Patient‐centred outcomes for oral vs IV iron | RR 1.71 [0.41, 7.18] | 3 studies · 206 participants | Very low Downgraded: imprecision |
Type of adverse event: allergic reactions/hypotension Patient‐centred outcomes for oral vs IV iron | RR 3.56 [1.88, 6.74] | 15 studies · 2607 participants | Low Downgraded: imprecision |
Type of adverse event: all gastrointestinal adverse effects Patient‐centred outcomes for oral vs IV iron | RR 0.47 [0.33, 0.66] | 14 studies · 1986 participants | Low Downgraded: imprecision, inconsistency, publication bias |
Type of adverse event: infection Patient‐centred outcomes for oral vs IV iron | RR 1.32 [0.9, 1.95] | 4 studies · 954 participants | Low Downgraded: imprecision |
Numbers of non‐dialysis patients needing to commence dialysis Patient‐centred outcomes for oral vs IV iron | RR 0.81 [0.41, 1.61] | 4 studies · 743 participants | Low Downgraded: imprecision |
Number requiring transfusion Patient‐centred outcomes for oral vs IV iron | RR 0.86 [0.55, 1.34] | 5 studies · 774 participants | Low Downgraded: imprecision |
Laboratory and pharmaceutical outcomes for adults and children with chronic kidney disease
Population: adults and children with CKD
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Number achieving target Hb or increase ≥1 g/dL | RR 1.71 [1.43, 2.04] | 13 studies · 2206 participants | Low Downgraded: risk of bias |
Hb: final or change (g/dL) | no estimate extracted | 31 studies · 3373 participants | Low Downgraded: risk of bias |
Ferritin: final or change (µg/L) | no estimate extracted | 33 studies · 3389 participants | Low Downgraded: risk of bias |
TSAT: final or change (%) | no estimate extracted | 27 studies · 3089 participants | Low Downgraded: risk of bias |
HCT (%) | no estimate extracted | 4 studies · 152 participants | Very low Downgraded: risk of bias |
ESA dose: final or change | no estimate extracted | 11 studies · 522 participants | Low Downgraded: risk of bias |
eGFR: final or change (mL/min) | no estimate extracted | 8 studies · 1052 participants | Low Downgraded: risk of bias |
Intravenous versus oral iron for adults and children with chronic kidney disease
Population: Adults and children with chronic kidney disease
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Haemoglobin: Final or change in all patients g/dL Intravenous vs oral iron | no estimate extracted | 22 studies · 1862 participants | Moderate Downgraded: inconsistency |
Ferritin: Final or change in all patients Intravenous vs oral iron | no estimate extracted | 24 studies · 1751 participants | Moderate Downgraded: inconsistency |
Transferrin saturation: Final or change in all patients Intravenous vs oral iron | no estimate extracted | 18 studies · 1457 participants | Moderate Downgraded: inconsistency |
Number achieving target haemoglobin or increase of 1 g/dL or more Intravenous vs oral iron | RR 1.7 [1.36, 2.12] | 10 studies · 1344 participants | Moderate Downgraded: inconsistency |
Intravenous versus oral iron in adults and children with chronic kidney disease: other outcomes
Population: Adults and children with chronic kidney disease
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
End of treatment or change in ESA dose Intravenous vs oral iron | no estimate extracted | 9 studies · 487 participants | Low Downgraded: inconsistency |
All‐cause mortality Intravenous vs oral iron | RR 1.16 [0.35, 3.84] | 5 studies · 435 participants | Moderate |
Cardiovascular mortality Intravenous vs oral iron | RR 3.2 [0.37, 27.51] | 2 studies · 70 participants | Low |