The Efficacy Of Intravenous Versus Oral Iron Therapy In Anemic Patients With Non-dialysis-dependent Chronic Kidney Disease: A Meta-analysis

Background: With the continuous development of society and science and technology,the improvement of people’s living standard and the continuous progress of medical diagnosis,the incidence of chronic renal insufficiency is increasingly high,which has become one of the major diseases endangering human health.Chronic renal insufficiency is a comprehensive disease,each system is likely to be affected,including anemia may occur in the early years of chronic renal insufficiency,and affect the quality of life of patients,patients with chronic renal insufficiency in anemia,called renal anemia,and according to its pathogenesis,and treatment of renal anemia is the main means of Erythropoietin(EPO,Erythropoietin)treatment,but recent studies have shown that iron is also an important means of treatment of renal anemia.At present,there are two main ways of iron supplementation in clinical practice: intravenous iron supplementation and oral iron supplementation,and each have advantages and disadvantages of two kinds of iron way,what kind of iron More suitable for chronic renal insufficiency anemia patients? According to the study of chronic renal insufficiency according to the severity of the disease become different periods,different clinical manifestations,in different historical periods for into uremia hemodialysis patients,every year there are a large number of iron loss,intravenous iron can quickly meet the demand of patients with iron,and relevant guidelines recommend but for non dialysis chronic renal insufficiency(ND-CKD)The iron status is completely different from that of dialysis patients,and there are still questions about which way of iron supplementation should be adopted for patients with ND-CKD.Objective:1.The efficacy of intravenous iron supplementation and oral iron supplementation in the treatment of ND-CKD anemia was evaluated by Meta analysis(by measuring the change of hemoglobin transferrin saturation ferritin);2.The incidence of adverse events in the treatment of ND-CKD anemia by intravenous iron supplementation and oral iron supplementation was assessed by Meta analysis.Methods:Oral iron intravenous iron patients non-dialysis-dependent chronic kidney disease rct was used as a key word to retrieve Cochrane Database Of Systematic Reviews,Central,MEDLINE,EMBASE database to find all of intravenous iron and oral iron therapy of ND-CKD patients with curative effect of all foreign randomized controlled trial(RCT)literature retrieval time as of December 1,2017,through the retrieval and screened into standard literature,extract data using Rev Man 5.0 software on the Meta analysis conclusion.Results: A total of 994 literatures were retrieved,and 11 high-quality foreign language RCT literatures were finally included by manual screening combined with inclusion and exclusion criteria.A total of 1707 patients were included,including 852 patients receiving intravenous iron supplementation and 855 patients receiving oral iron supplementation.1.Hemoglobin levels can be significantly increased by intravenous iron supplementation versus oral iron supplementation.(WMD 0.39g/dL,95% CI,0.26-0.52;P<0.00001);2.Transferrin saturation(TSAT)can be significantly increased by intravenous iron supplementation versus oral iron supplementation(WMD 3.97%,95% CI,2.24-5.7;P< 0.00001);3.Intravenous iron supplementation significantly increased ferritin levels compared with oral iron supplementation(WMD 244.51ng/mL,95% CI,185.51-303.52;P<0.00001);4.There was no significant difference in the incidence of adverse events between intravenous iron supplementation and oral iron supplementation(RR 0.79,95% CI,0.44-1.44;P = 0.45).Conclusions: 1.Intravenous iron supplementation can better improve hemoglobin level in patients with ND-CKD anemia;2.Intravenous iron supplementation in patients with ND-CKD anemia can better improve ferritin saturation;3.Intravenous iron supplementation in patients with ND-CKD anemia can better improve ferritin,but it is closely related to iron supplementation dose;4.There was no significant difference in the incidence of adverse events between oral iron supplementation and intravenous iron supplementation.