Chan Bernard, Varghese Amanda, Badve Sunil V, Pecoits-Filho Roberto, Guedes Murilo, Arnott Clare, Kozor Rebecca, O'Lone Emma, Jun Min, Kotwal Sradha, Block Geoffrey A, Chertow Glenn M, Solomon Scott D, Vaduganathan Muthiah, Perkovic Vlado, Neuen Brendon L
Department of Cardiology, Royal North Shore Hospital, Sydney, New South Wales, Australia.
Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
Kidney Int Rep. 2025 Jan 29;10(4):1037-1049. doi: 10.1016/j.ekir.2025.01.029. eCollection 2025 Apr.
Heart failure and chronic kidney disease (CKD) are closely associated, and iron deficiency is highly prevalent in both conditions. However, major cardiovascular and nephrology guidelines offer contrasting recommendations for iron use. We evaluated the effects of iron versus usual care or placebo on the clinical outcomes in patients with CKD.
We conducted a systematic review and meta-analysis of randomized trials on i.v. or oral iron in patients with CKD (PROSPERO CRD42023453468). We searched Medline, Embase, and the Cochrane Register from database inception until February 1, 2024 to identify eligible trials. We determined the overall results and stratified them by dialysis- and nondialysis-requiring CKD using random effects models, with certainty of evidence assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. The primary composite endpoint was hospitalization for heart failure or cardiovascular death.
We identified 45 trials that met the inclusion criteria. Compared with usual care or placebo, iron reduced the risk of the primary composite endpoint (1659 events; risk ratio [RR]: 0.84, 95% confidence interval [CI]: 0.75-0.94; moderate certainty), an effect consistent across dialysis and nondialysis requiring CKD (-heterogeneity = 0.70). The effect on the primary endpoint appeared driven by both components of hospitalization for heart failure (RR: 0.77; 95% CI: 0.61-0.96; moderate certainty) and cardiovascular death (RR: 0.81; 95% CI: 0.65-1.02; low certainty). The incidence of serious adverse events was lower for iron compared with usual care or placebo (RR: 0.90, 95% CI: 0.82-0.98; moderate certainty; -heterogeneity = 0.09).
Iron therapy may reduce the risk of heart failure and cardiovascular death in patients with CKD. Randomized trials evaluating the effects of iron on clinical outcomes are needed, especially in nondialysis patients with CKD with or without anemia.
心力衰竭与慢性肾脏病（CKD）密切相关，缺铁在这两种疾病中都极为常见。然而，主要的心血管和肾脏病学指南对铁剂的使用给出了相互矛盾的建议。我们评估了铁剂与常规治疗或安慰剂相比，对CKD患者临床结局的影响。
我们对CKD患者静脉或口服铁剂的随机试验进行了系统评价和荟萃分析（PROSPERO CRD42023453468）。我们检索了从数据库建立至2024年2月1日的Medline、Embase和Cochrane注册库，以确定符合条件的试验。我们使用随机效应模型确定总体结果，并按需要透析和不需要透析的CKD进行分层，使用推荐分级评估、制定和评价方法评估证据的确定性。主要复合终点是因心力衰竭住院或心血管死亡。
我们确定了45项符合纳入标准的试验。与常规治疗或安慰剂相比，铁剂降低了主要复合终点的风险（1659例事件；风险比[RR]：0.84，95%置信区间[CI]：0.75-0.94；中等确定性），在需要透析和不需要透析的CKD中效果一致（异质性I² = 0.70）。对主要终点的影响似乎由心力衰竭住院（RR：0.77；95%CI：0.61-0.96；中等确定性）和心血管死亡（RR：0.81；95%CI：0.65-1.02；低确定性）的两个组成部分驱动。与常规治疗或安慰剂相比，铁剂导致的严重不良事件发生率更低（RR：0.90，95%CI：0.82-0.98；中等确定性；异质性I² = 0.09）。
铁剂治疗可能降低CKD患者心力衰竭和心血管死亡的风险。需要进行评估铁剂对临床结局影响的随机试验，尤其是在患有或未患有贫血的非透析CKD患者中。
