Intravenous vs Oral Iron not tied with increased CKD Risk individuals with normal kidney function

Parenteral (IV) iron is effective in treating iron deficiency, but there are concerns about its potential nephrotoxicity. However, little is known about the long-term comparative renal safety of oral vs IV iron in patients with normal kidney function. We aimed to investigate the association of oral vs IV iron with the incidence of new onset chronic kidney disease (CKD).

They identified 94,931 incident new users of iron replacement therapy (N=91,945 on oral and 2,986 on IV iron) from 2004-2018 in a large national cohort of US Veterans. We used clinical trial emulation methods including propensity score (PS) matching to account for differences in key baseline characteristics and limited the cohort to patients with eGFR >60 ml/mi/1.73m2 and urine albumin creatinine ratio (UACR) <30 mg/g. We examined the association of oral vs IV iron with the incidence of eGFR <60 ml/min/1.73m2 and UACR >30 mg/g (both defined as two values at least 90 days apart) using competing risk regression.

The result:

• In the PS matched cohort there were 1,029 patients on oral and 1,043 on IV iron with eGFR ≥60 ml/min/1.73m2 and UACR <30 mg/g at baseline.
• Their characteristics were well balanced, with an overall mean (SD) age of 66±12 years, 92% male, 75% white, and baseline eGFR, hemoglobin and ferritin levels of 90±18 ml/min/1.73m2, 9.7±1.8 g/dL and 34 µg/L, respectively.
• There were 370 cases of incident GFR <60 and 251 cases of incident albuminuria over a median follow-up of 1.8 years.
• IV (vs oral) iron therapy was associated with similar risk of incident eGFR <60 and incident albuminuria

In this large national cohort of patients with baseline normal kidney function and no proteinuria, IV iron therapy was not associated with higher risk of incident CKD when compared to oral iron.

Reference:

Shrestha P, Paul S, Sumida K, et al. Association of parenteral vs. oral iron therapy with incident CKD. Presented at: Kidney Week 2022; November 3-6, Orlando, Florida. Abstract TH-PO682.

Keywords:

Shrestha P, Paul S, Sumida K, Intravenous (IV) vs oral iron therapy is not associated with a higher risk for new-onset chronic kidney disease (CKD) among individuals with normal kidney function and no proteinuria, investigators reported at the American Society of Nephrology's Kidney Week 2022 conference in Orlando, Florida

Parenteral (IV) iron is effective in treating iron deficiency, but there are concerns about its potential nephrotoxicity. However, little is known about the long-term comparative renal safety of oral vs IV iron in patients with normal kidney function. We aimed to investigate the association of oral vs IV iron with the incidence of new onset chronic kidney disease (CKD).

They identified 94,931 incident new users of iron replacement therapy (N=91,945 on oral and 2,986 on IV iron) from 2004-2018 in a large national cohort of US Veterans. We used clinical trial emulation methods including propensity score (PS) matching to account for differences in key baseline characteristics and limited the cohort to patients with eGFR >60 ml/mi/1.73m2 and urine albumin creatinine ratio (UACR) <30 mg/g. We examined the association of oral vs IV iron with the incidence of eGFR <60 ml/min/1.73m2 and UACR >30 mg/g (both defined as two values at least 90 days apart) using competing risk regression.

The result:

• In the PS matched cohort there were 1,029 patients on oral and 1,043 on IV iron with eGFR ≥60 ml/min/1.73m2 and UACR <30 mg/g at baseline.
• Their characteristics were well balanced, with an overall mean (SD) age of 66±12 years, 92% male, 75% white, and baseline eGFR, hemoglobin and ferritin levels of 90±18 ml/min/1.73m2, 9.7±1.8 g/dL and 34 µg/L, respectively.
• There were 370 cases of incident GFR <60 and 251 cases of incident albuminuria over a median follow-up of 1.8 years.
• IV (vs oral) iron therapy was associated with similar risk of incident eGFR <60 and incident albuminuria

In this large national cohort of patients with baseline normal kidney function and no proteinuria, IV iron therapy was not associated with higher risk of incident CKD when compared to oral iron.

Reference:

Shrestha P, Paul S, Sumida K, et al. Association of parenteral vs. oral iron therapy with incident CKD. Presented at: Kidney Week 2022; November 3-6, Orlando, Florida. Abstract TH-PO682.

Keywords:

Shrestha P, Paul S, Sumida K, Association, parenteral, oral, iron, therapy, incident CKD, Kidney Week 2022, parenteral, oral, iron, therapy, incident CKD, Kidney Week 2022