Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Nov 27:4:1488758.
doi: 10.3389/fneph.2024.1488758. eCollection 2024.

Comparative iron management in hemodialysis and peritoneal dialysis patients: a systematic review

Thomas S van Lieshout  1   2   3 , Anastasia K Klerks  4 , Osman Mahic  4   5 , Robin W M Vernooij  4   5 , Michele F Eisenga  6 , Brigit C van Jaarsveld  1   3   7 , Alferso C Abrahams  4
Affiliations

Comparative iron management in hemodialysis and peritoneal dialysis patients: a systematic review

Thomas S van Lieshout et al. Front Nephrol. .

Abstract

Background: Patients with kidney failure undergoing dialysis often suffer from anemia. Iron deficiency, along with a shortage in erythropoietin, is a common cause. Peritoneal dialysis (PD) patients may have a different iron metabolism compared to hemodialysis (HD) patients. This study aims to compare both dialysis modalities regarding their differences in iron management.

Methods: PubMed (MEDLINE) and Embase were screened for randomized controlled trials and observational studies including both patients on HD or PD with information on iron management. Outcomes for iron management for this systematic review included: prevalence of supplementation, route of administration, dose, frequency and hemoglobin and iron status parameters.

Results: 15 eligible studies (930,436 patients), of which 8 cohort and 7 cross-sectional, were analyzed. The prevalence of intravenous (IV) iron supplementation ranged from 11.7% to 84.4% in HD patients, compared to 1.6% to 49.0% in PD patients. Ten studies reported that HD patients only received IV iron, while five studies reported this for PD patients. For oral iron supplementation, three studies involved HD patients, whereas seven studies involved PD patients. The cumulative monthly IV iron dose ranged from 108 to 750 mg in the HD group, compared to 65 to 250 mg in the PD group. Hemoglobin levels ranged from 10.0 to 12.0 g/dL in HD patients, versus 9.6 to 11.9 g/dL in PD patients.

Conclusion: Iron management differs between HD and PD patients, with HD patients receiving higher doses and more frequent IV iron. There was significant heterogeneity in the outcomes between the studies, primarily due to the lack of a uniform global policy on iron management. Despite these differences, hemoglobin levels and iron status parameters were comparable between the two groups. Future research should explore the underlying mechanisms and broader impacts of iron treatment, including patient-reported outcomes, to optimize anemia management and improve quality of life for dialysis patients.

Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42022336970.

Keywords: anemia; hemodialysis; iron therapy; kidney failure; peritoneal dialysis.

PubMed Disclaimer

Conflict of interest statement

AA has received speaker honoraria from Baxter Healthcare, Fresenius Medical Care, AstraZeneca and Cablon Medical. BvJ has received speaker honoraria from Fresenius Medical Care and CSL Vifor. ME has declared receiving consultant fees from Vifor Pharma and Cablon Medical; received grants from Cablon Medical and Astellas; serving on the Advisory Board for Cablon Medical, GlaxoSmithKline and Medice; and receiving speaker fees from Vifor Pharma, Pharmacosmos, and Astellas In all instances all to employer. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

Figures

Figure 1
Figure 1
PRISMA flowchart (58).
Figure 2
Figure 2
Prevalence of iron therapy. (A) Difference in IV iron use between HD and PD, (B) Difference in oral iron use between HD and PD; Gao, Malyszko, Matsumura, Niikura presented IV iron use prevalences for HD patients and oral iron use prevalences for PD patients; HD, hemodialysis; PD, peritoneal dialysis; IV, intravenous; *Value reported as range.
Figure 3
Figure 3
Dose and frequency of iron therapy (A), Mean dose of IV iron administration per 30 days (month) in mg, (B), Mean dose of oral iron administration per 30 days (month) in mg, (C), Frequency of iron administration per 30 days (month); Matsutsumura presented IV iron dose for HD patients and oral iron dose for PD patients; Wetmore and Zitt described frequency only for patients receiving intravenous treatment; HD, hemodialysis; PD, peritoneal dialysis; Hb, hemoglobin; IV, intravenous; *Value reported as range.
Figure 4
Figure 4
Anemia and iron serum markers. (A) Difference in mean Hb between HD and PD, (B) Difference in mean ferritin between HD and PD, (C) Difference between mean TSAT between HD and PD; HD, hemodialysis; PD, peritoneal dialysis; Hb, hemoglobin; TSAT, transferrin saturation; *Value reported as median with interquartile range.
Figure 5
Figure 5
Summary of findings of the systematic review describing differences in iron management between HD and PD patients. (A) Prevalence of IV iron supplementation ranged from 11.7% to 84.4% in HD patients and 1.6% to 49.0% in PD patients. Prevalence of oral iron supplementation ranged from 1.0% to 97.6% in HD patient and 12.0% to 100.0% in PD patients; (B) Difference in route of iron administration between HD and PD patients; (C) Difference in mean IV iron dose in mg per month between HD and PD patients. HD patients ranged from 108 mg to 750 mg and PD patients from 62.5 mg to 250 mg; (D) Differences in anemia and iron serum markers between HD and PD patients. For Hb HD patients ranged from 10.0 to 12.0 g/dL and PD patients from 9.6 g/dL and 11.9 g/dL. For ferritin HD patients ranged from 50 ng/ml to 430 ng/ml and PD patient from 116.9 ng/ml to 352 ng/ml. For TSAT HD patients ranged from 10% to 40% and PD patient from 26% to 39%; HD, hemodialysis; PD, peritoneal dialysis; IV, intravenous; TSAT, transferrin saturation.
See this image and copyright information in PMC

References

    1. Stauffer ME, Fan T. Prevalence of anemia in chronic kidney disease in the United States. PloS One. (2014) 9:e84943–e. doi: 10.1371/journal.pone.0084943 - DOI - PMC - PubMed
    1. Eschbach JW, Adamson JW. Anemia of end-stage renal disease (ESRD). Kidney Int. (1985) 28:1–5. doi: 10.1038/ki.1985.109 - DOI - PubMed
    1. Kovesdy CP, Davis JR, Duling I, Little DJ. Prevalence of anaemia in adults with chronic kidney disease in a representative sample of the United States population: analysis of the 1999-2018 National Health and Nutrition Examination Survey. Clin Kidney J. (2023) 16:303–11. doi: 10.1093/ckj/sfac240 - DOI - PMC - PubMed
    1. Gunnell J, Yeun JY, Depner TA, Kaysen GA. Acute-phase response predicts erythropoietin resistance in hemodialysis and peritoneal dialysis patients. Am J Kidney diseases: Off J Natl Kidney Foundation. (1999) 33:63–72. doi: 10.1016/S0272-6386(99)70259-3 - DOI - PubMed
    1. Batchelor EK, Kapitsinou P, Pergola PE, Kovesdy CP, Jalal DI. Iron deficiency in chronic kidney disease: updates on pathophysiology, diagnosis, and treatment. J Am Soc Nephrology: JASN. (2020) 31:456–68. doi: 10.1681/ASN.2019020213 - DOI - PMC - PubMed

Publication types

LinkOut - more resources