A Systematic Review Investigates the Safety and Efficacy of Intravenous Iron Dosing in Peritoneal Dialysis.

Abstract

Aims/Background Anaemia is a common complication in chronic kidney disease, particularly in people with advanced kidney failure, contributing to increased morbidity and mortality. Iron repletion and erythropoietin-stimulating agents are widely used to manage anaemia, reducing the need for blood transfusions. However, these treatments carry risks, including thrombosis and cardiovascular issues. While intravenous iron is an established therapy for people receiving haemodialysis, its safety and efficacy in people undergoing peritoneal dialysis remain uncertain, partly due to limited data. This review assesses the current evidence on intravenous iron for managing anaemia in peritoneal dialysis, focusing on its impact on iron status, safety, and clinical outcomes. Methods Systematic searches of MEDLINE, Embase, Cochrane Library, HMIC, AMED and CINAHL were conducted. All eligible studies investigating intravenous iron therapy in adults with end-stage kidney failure undergoing peritoneal dialysis were included. The risk of bias was assessed using the Joanna Briggs Institute checklists for randomised, quasi-randomised and cohort studies. Sensitivity analysis was performed by comparing fixed and random effects models, removing outliers and performing a leave-one-out analysis. Studies had considerable heterogeneity when tested with Cochran's Q Test and the I² statistic. Where meta-analyses were not possible, narrative syntheses were conducted due to expected variations in iron dosing and monitoring practices, allowing for a more contextualised analysis of the data across heterogeneous study designs. Results 9 studies were included (3 studies compared intravenous to oral iron). The mean ferritin increase was 153.07 ng/mL (95% confidence interval (CI): 107.30-198.84; p < 0.0001) after sensitivity analysis. The mean transferrin saturation increase was 9.29% (95% CI: 2.98-15.61; p = 0.0039). Conclusion Despite the variability, the included studies consistently show that intravenous (IV) iron improves ferritin, transferrin saturation, haemoglobin, and haematocrit levels, while reporting few adverse events. Future research should focus on optimal dosing, safety, and outcomes beyond anaemia, such as cardiovascular health and quality of life, to maximise patient benefits. Systematic Review Registration PROSPERO (CRD42022363043).