Date of publication: November 3, 2014

Expert Perspectives

Expert Panel Discussion: Oral vs. IV Iron Therapy

Iron therapy is an essential component of treating iron deficiency/iron deficiency-anaemia (ID/IDA) in patients with non-dialysis chronic kidney disease (ND-CKD); however, the best route of administration, intravenous (IV) or oral, remains an area of debate.(1,2) Meta-analysis of several studies is one approach to increase the power of detecting a statistically- and clinically-meaningful difference in efficacy between the two treatment options.(3) However, the considerable difference in study design (e.g. patient numbers, study duration and inclusion criteria) for clinical trials of patients with ND-CKD means that any findings from meta-analyses should be interpreted with caution.1,2

In the first of our roundtable series, our experts discuss the findings from recent systematic reviews and meta-analyses of studies that compare IV and oral iron in ND-CKD, and provide their thoughts on the clinical trials evaluated. They also explore how some randomised controlled trials in other chronic conditions have moved away from traditional ‘hard’ endpoints, such as mortality and hospitalisation, and towards patient-reported outcomes, including quality of life and exercise capacity, and how these have been used to design the latest ND-CKD studies.

The expert panel comprised Professors Simon Roger (Chair), Carlo Gaillard and Iain Macdougall.


  1.  Albaramki J, Hodson EM, Craig JC, et al. Parenteral versus oral iron therapy for adults and children with chronic kidney disease. Cochrane Database Syst Rev 2012;1:CD007857.
  2. Rozen-Zvi B, Gafter-Gvili A, Paul M, et al. Intravenous versus oral iron supplementation for the treatment of anemia in CKD: systematic review and meta-analysis. Am J Kidney Dis 2008;52:897–906.
  3. Garg AX, Hackam D, Tonelli M. Systematic review and meta-analysis: when one study is just not enough. Clin J Am Soc Nephrol 2008;3:253–260.



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