ArticleClinical kidney journal2026
A systematic review investigating the safety and efficacy of intravenous iron in people with ND-CKD who are iron deficient but not anaemic.
Article in Clinical kidney journal, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: The role of intravenous (IV) iron in non-dialysis-dependent chronic kidney disease (ND-CKD) without anaemia remains uncertain. Iron deficiency (ID) in CKD is common and associated with impaired mitochondrial function, fatigue, cognitive decline, and restless legs syndrome, even when haemoglobin (Hb) levels are normalized. ID is linked to cardiovascular (CV) outcomes and increased hospitalization risk. Guidelines are inconsistent, and the evidence base is limited. Methods: Databases were searched for randomized controlled trials (RCTs) and cohort studies involving adults with ND-CKD (estimated glomerular filtration rate [eGFR] < 60) receiving IV iron compared with oral iron, placebo, or no treatment. Primary outcome was change in iron indices. Secondary outcomes: CV events, infections, physical function, symptoms, cognition, and quality of life (QoL). Results: Six studies met the inclusion criteria. In pooled analyses restricted to RCTs, IV iron significantly improved TSAT [mean difference (MD) +7.48%, 95% CI 5.64-9.32; Conclusions: IV iron improves biochemical markers of ID in ND-CKD without anaemia, with no clear signal of harm. However, evidence does not demonstrate measurable improvements in physical function or QoL.
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