Oral Iron Found to Be the Optimal First Treatment

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LAS VEGAS—Oral iron is the optimal first treatment strategy for most iron-deficient, anemic chronic kidney disease (CKD) patients not yet on dialysis, a recent analysis shows.

Investigators at Geisinger Medical Center in Danville, Pa., compared oral and intravenous (IV) iron as initial treatment for newly anemic (hemoglobin [Hg] levels below 10 g/dL) iron-deficient patients with non-dialysis-dependent stage 3 or 4 CKD. From a retrospective cohort (2004-2009) of adult patients at Geisinger, they derived the probabilities of cardiovascular events and blood transfusions as well as direct health care costs incorporating hematologic response and downstream use of erythropoiesis-stimulating agents.

Over the course of 4.0 years follow-up, for average and robust responders to oral iron therapy (as measured by probability of achieving a hemoglobin of 11.0 g/dL or greater), an initial strategy of oral vs. intravenous iron was associated with modestly higher

effectiveness (0-80 quality-adjusted life-days) and lower costs (cost savings range $2,500-$12,000), the researchers reported at the National Kidney Foundation's Spring Clinical Meetings.

Among those with the poorest early hematologic response to oral iron therapy, IV iron was modestly more effective (18 quality-adjusted life days) and cost-saving ($300), but sensitive to background health care resource utilization.

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