Clinical efficacy and safety of IV ferric carboxymaltose in restless legs syndrome: A meta-analysis of 537 patients.

BACKGROUND: Recent research indicates that intravenous ferric carboxymaltose (IV FCM) presents a promising solution for Restless Legs Syndrome (RLS), distinguishing itself from other iron sources with minimal to no adverse effects. We conducted a systematic review and meta-analysis to evaluate the efficacy and safety profile of administering IV FCM in patients with RLS, assuming that RLS and Iron deficiency anemia (IDA) are correlated. METHODOLOGY: This study was conducted according to the PRISMA guideline, with search conducted on PubMed, Google Scholar, and the Medline library. Data was extracted from each study regarding RLS and the effect of IV FCM on it, while analysis was conducted on Review Manager Software. RESULTS: This meta-analysis comprises of 7 randomized controlled trials (RCTs). All 7 studies reported international RLS severity scale (IRLS) and the pooled analysis revealed a significant reduction in IRLS score favoring IV FCM [WMD: -6.03, 95 % CI (-10.11, -1.96), p = 0.004]. 3 out of 7 studies reported short form-36 health survey (SF-36) and the pooled analysis revealed that the total score of SF-36 significantly favors the group taking IV FCM [WMD: 7.44, 95%CI (1.67, 13.20) p = 0.01]. 4 out of 7 studies reported visual analogue scale (VAS) for RLS severity and pooled analysis revealed that IV FCM significantly decreased VAS) of RLS severity score as compared to the control [MD -19.21, 95%CI (-31.90, -6.52) p0.003]. CONCLUSION: The study findings support the efficacy of IVFCM in reducing the severity of RLS symptoms. Significant improvements in the IRLS scores were observed, alongside enhancements in overall quality of life measured by SF-36 scores.

Intravenous iron versus blood transfusion for postpartum anemia: a systematic review and meta-analysis.

BACKGROUND: Intravenous iron (IV-iron) is used as an alternative to, or alongside, red blood cell transfusion (RBC-T) to treat more severe postpartum anemia (PPA), although optimal treatment options remain unclear. No previous systematic reviews have examined IV-iron and RBC-T, including patient-reported outcomes and hematological responses. METHODS: A systematic review and meta-analysis of randomized trials comparing IV-iron and RBC-T with each other, oral iron, no treatment, and placebo for the treatment of PPA. Key inclusion criteria were PPA (hemoglobin < 12 g/dL) and IV-iron or RBC-T as interventions. Key exclusion criteria were antenatal IV-iron or RBC-T. Fatigue was the primary outcome. Secondary outcomes included hemoglobin and ferritin concentrations, and adverse events. From 27th August 2020 to 26th September 2022, databases, registries, and hand searches identified studies. A fixed-effect meta-analysis was undertaken using RevMan (5.4) software. The quality of the studies and the evidence was assessed using the Cochrane Risk of Bias table, and Grading of Recommendations, Assessment, Development, and Evaluation. This review is registered with the Prospective Register of Systematic Reviews (CRD42020201115). RESULTS: Twenty studies and 4196 participants were included: 1834 assigned IV-iron, 1771 assigned oral iron, 330 assigned RBC-T, and 261 assigned non-intervention. Six studies reported the primary outcome of fatigue (1251 participants). Only studies of IV-iron vs. oral iron (15 studies) were available for meta-analysis. Of these, three reported on fatigue using different scales; two were available for meta-analysis. There was a significant reduction in fatigue with IV-iron compared to oral iron (standardized mean difference - 0.40, 95% confidence interval (CI) - 0.62, - 0.18, I2 = 0%). The direction of effect also favored IV-iron for hemoglobin (mean difference (MD) 0.54 g/dL, 95% confidence interval (CI) 0.47, 0.61, I2 = 91%), ferritin, (MD 58.07 mcg/L, 95% CI 55.74, 60.41, I2 = 99%), and total adverse events (risk-ratio 0.63, 95% CI 0.52, 0.77, I2 = 84%). The overall quality of the evidence was low-moderate. DISCUSSION: For all outcomes, the evidence for RBC-T, compared to IV-iron, non-intervention, or dose effects of RBC-T is very limited. Further research is needed to determine whether RBC-T or IV-iron for the treatment of PPA is superior for fatigue and hematological outcomes.

The fatigue after infusion or transfusion pilot trial and feasibility study: A three-armed randomized pilot trial of intravenous iron and blood transfusion for the treatment of postpartum anemia.

BACKGROUND: Evidence for the management of moderate-to-severe postpartum anemia is limited. A randomized trial is needed; recruitment may be challenging. STUDY DESIGN AND METHODS: Randomized pilot trial with feasibility surveys. INCLUSION: hemoglobin 65-79 g/L, ≤7 days of birth, hemodynamically stable. EXCLUSION: ongoing heavy bleeding; already received, or contraindication to intravenous (IV)-iron or red blood cell transfusion (RBC-T). Intervention/control: IV-iron; RBC-T; or IV-iron and RBC-T. PRIMARY OUTCOME: number of recruits; proportion of those approached; proportion considered potentially eligible. SECONDARY OUTCOMES: fatigue, depression, baby-feeding, and hemoglobin at 1, 6 and 12 weeks; ferritin at 6 and 12 weeks. Surveys explored attitudes to trial participation. RESULTS: Over 16 weeks and three sites, 26/34 (76%) women approached consented to trial participation, including eight (31%) Maori women. Of those potentially eligible, 26/167 (15.6%) consented to participate. Key participation enablers were altruism and study relevance. For clinicians and stakeholders the availability of research assistance was the key barrier/enabler. Between-group rates of fatigue and depression were similar. Although underpowered to address secondary outcomes, IV-iron and RBC-T compared with RBC-T were associated with higher hemoglobin concentrations at 6 (mean difference [MD] 11.7 g/L, 95% confidence interval [CI] 2.7-20.7) and 12 (MD 12.8 g/L, 95% CI 1.5-24.2) weeks, and higher ferritin concentrations at 6 weeks (MD 136.8 mcg/L, 95% CI 76.6-196.9). DISCUSSION: Willingness to participate supports feasibility for a future trial assessing the effectiveness of IV-iron and RBC-T for postpartum anemia. Dedicated research assistance will be critical to the success of an appropriately powered trial including women-centered outcomes.

Prevalence, treatment status, medical costs, quality of life, and productivity loss in Japanese adult patients with anemia: a real-world database study.

AIMS: To investigate the prevalence, treatment status, and effect of anemia on medical costs, quality of life (QOL), and productivity loss in Japan. METHODS: This cross-sectional study used a database containing claims, health check-ups, and questionnaire data. Adults with hemoglobin data at 2020 check-ups were included. QOL and productivity loss were evaluated using EuroQol 5-Dimension (EQ-5D) and Work Productivity and Activity Impairment questionnaire data available for a subset of the population. Nationwide anemia prevalence, including both diagnosed as having anemia and undiagnosed but with low hemoglobin levels, were estimated. Treatment status was described by hemoglobin levels. Differences in medical costs, QOL, and productivity loss were compared between individuals with and without anemia. Subgroup analyses were performed using the Charlson Comorbidity Index (CCI). RESULTS: The study population included 554,798 individuals. Anemia prevalence was estimated at 15.1% with 55.3% undiagnosed. In patients with anemia, 85.3% were untreated; 79.5% of the treated patients received only oral iron drugs. In patients with anemia, monthly medical costs were ¥17,766 higher, EQ-5D score was 0.0118 lower, and productivity loss was 2.6% higher than in those without anemia. The trends were consistent even in limited patients with CCI = 0. Nationwide annual excess medical costs, deficit QOL, and productivity loss in patients with anemia were estimated at ¥3.32 trillion, 138,000 quality-adjusted life-years, and ¥1.13 trillion, respectively. LIMITATIONS: As the study population only included individuals who underwent health check-ups, they may be healthier than general population. Whether the differences in medical costs, QoL, and productivity loss are caused by anemia or other underlying differences in patient characteristics is unclear, given the likelihood of residual confounding. CONCLUSIONS: The results suggest that more than half of patients with anemia were undiagnosed and untreated. Patients with anemia had higher medical costs, lower QOL, and greater productivity loss than those without anemia.

Hypophosphatemia related to intravenous iron therapy with ferric carboxymaltose: A case series.

OBJECTIVES: This case series would like to highlight hypophosphatemia related to ferric carboxymaltose and its adverse clinical consequences. BACKGROUND: Intravenous iron supplementation is a good alternative to oral iron replacement in iron deficiency anaemia due to its ability to correct iron deficit with minimal infusions without incurring the gastrointestinal side effects of oral iron replacement. Ferric carboxymaltose is one common formula for intravenous iron supplementation. However, an increasingly recognised adverse side-effect of intravenous ferric carboxymaltose is hypophosphatemia. There has been increasing reports and studies highlighting hypophosphatemia related to intra-venous iron therapy. Though initially thought to be transient and asymptomatic, recent studies have shown that persistent hypophosphatemia in iron therapy can result in debilitating disease including myopathy, fractures and osteomalacia. METHODS: A retrospective analysis of all patients who had ferric carboxymaltose was performed. RESULTS: We highlight 3 cases where hyposphatemia affected the clinical outcomes. CONCLUSION: With the increased use of IV iron it is important to be aware of the high potential for hypophosphatemia secondary to ferric carboxymaltose.

The Influence of Hemostatic Agents and Cordless Gingival Retraction Materials on Smear Layer: An Ex vivo Scanning Electron Microscope Analysis.

CONTEXT: Cordless gingival retraction materials are now routinely used method for gingival retraction. Although evidence-based information is available on the effect of gingival displacement cord and cordless system on the effectiveness of displacement and the periodontal health, there is a lack of literature regarding the effect of cordless retraction agents on enamel and dentin substrates. AIM: The purpose of this investigation was to analyze the changes on the smear layer induced by the hemostatic agent and cordless retraction material at scanning electron microscopic level. MATERIALS AND METHODS: Ferric sulfate (15.5% m/v), expasyl, and magic foam cord were evaluated. Buccal surfaces of 16 recently extracted mandibular premolars were prepared for metal-ceramic crowns, and four teeth each were exposed to ferric sulfate solution, expasyl, and magic foam cord, respectively, for 5 min. Teeth in the control group were exposed to distilled water. The assessment of changes was performed using a scanning electron microscope (SEM). RESULTS: SEM exhibited smear layer covering the dentin and occluding the dentinal tubules in the control group. Exposure to ferric sulfate caused the opening of few of the dentinal tubules whereas expasyl caused the partial removal of smear layer with dentinal plugs partially occluding the openings of most of the dentinal tubules. The specimens treated with magic foam exhibited a smear layer similar to the control group. CONCLUSIONS: The smear layer was affected most with ferric sulfate solution, followed by expasyl and magic foam cord. Magic foam cord did not affect the smear layer.

In acute HF and iron deficiency, IV ferric carboxymaltose reduced HF hospitalizations, but not CV death, at 1 y.

SOURCE CITATION: Ponikowski P, Kirwan BA, Anker SD, et al. Lancet. 2020;396:1895-904. 33197395.

Hierro carboximaltosa por vía intravenosa para tratamiento de la anemia ferropénica en pacientes con hemorragia uterina anormal / Intravenous ferric carboxymaltose injection for treatment iron deficiency anemia in abnormal uterine bleeding

Resumen OBJETIVO: Evaluar la eficacia y seguridad de la administración de altas dosis de hierro carboximaltosa en el tratamiento de pacientes con anemia ferropénica secundaria a hemorragia uterina anormal. MATERIAL Y MÉTODOS: Estudio cuasiexperimental de intervención, no controlado, con la variedad antes y después de un solo grupo (pretest-postest) efectuado en el Hospital Río de la Loza entre mayo de 2014 y septiembre de 2018. Criterios de inclusión: pacientes de 18 años o mayores con anemia y hemorragia uterina anormal severa. Criterios de exclusión: transfusión de concentrados eritrocitarios o administración de hierro parenteral en las ocho semanas previas al estudio, etc. Variables de estudio: hemoglobina, hematocrito, volumen corpuscular medio, concentración de hemoglobina corpuscular media, plaquetas y concentraciones de ferritina y plaquetas. RESULTADOS: Se analizaron los datos de 18 pacientes con anemia ferropénica secundaria a hemorragia uterina anormal 13 de 18 experimentaron un incremento de 2 g/dL o mayor de hemoglobina , 9 de 18 obtuvieron un incremento de 2.5 o mayor y solo 7 de 18 obtuvieron un incremento de 3 g/dL o mayor, los incrementos fueron dependientes de las dosis administrada. La ferritina sérica final promedio fue de 33.44 mcg/L. No hubo efectos adversos graves reportados. CONCLUSIONES: En este grupo de pacientes con anemia ferropénica, la administración de hierro carboximaltosa por vía intravenosa a dosis altas fue segura en la corrección de la carencia del mineral secundaria a hemorragia uterina anormal y en el reabastecimiento de los depósitos de hierro.

Abstract OBJECTIVE: The objective was to evaluate efficacy and safety of rapid, large-dose intravenous (IV) administration of ferric carboxymaltose in correcting iron deficiency anemia due to abnormal uterine bleeding. MATERIAL AND METHODS: Quasi-experimental study of intervention, not controlled, with the variety before and after a single group (pretest-posttest) carried out in the Hospital Río de la Loza, Mexico, between May 2014 and September 2018. Inclusion criteria: patients 18 years of age or older with anemia and severe abnormal uterine hemorrhage. Exclusion criteria: transfusion of erythrocyte concentrates or administration of parenteral iron in the eight weeks prior to the study, etc. Study variables: hemoglobin, hematocrit, mean corpuscular volume, mean corpuscular hemoglobin concentration, platelets and concentrations of ferritin and platelets. RESULTS: 13 patients of 18 obtained an increase of 2 g/dL or greater of hemoglobin, 9 of 18 obtained an increase of 2.5 or greater and only 7 of 18 obtained an increase of 3g/dL or greater, the increases were dependent on the administered dose. The average final serum ferritin was 33.44 mcg/L. There were no serious adverse effects reported. CONCLUSIONS: The use of iron carboxymaltose intravenously at high doses is a safe treatment in the correction of iron deficiency anemia secondary to abnormal uterine hemorrhage and in the replenishment of iron stores.

Ferumoxytol-enhanced magnetic resonance angiography for the assessment of potential kidney transplant recipients.

OBJECTIVES: Traditional contrast-enhanced methods for scanning blood vessels using magnetic resonance imaging (MRI) or CT carry potential risks for patients with advanced kidney disease. Ferumoxytol is a superparamagnetic iron oxide nanoparticle preparation that has potential as an MRI contrast agent in assessing the vasculature. METHODS: Twenty patients with advanced kidney disease requiring aorto-iliac vascular imaging as part of pre-operative kidney transplant candidacy assessment underwent ferumoxytol-enhanced magnetic resonance angiography (FeMRA) between December 2015 and August 2016. All scans were performed for clinical indications where standard imaging techniques were deemed potentially harmful or inconclusive. Image quality was evaluated for both arterial and venous compartments. RESULTS: First-pass and steady-state FeMRA using incremental doses of up to 4 mg/kg body weight of ferumoxytol as intravenous contrast agent for vascular enhancement was performed. Good arterial and venous enhancements were achieved, and FeMRA was not limited by calcification in assessing the arterial lumen. The scans were diagnostic and all patients completed their studies without adverse events. CONCLUSIONS: Our preliminary experience supports the feasibility and utility of FeMRA for vascular imaging in patients with advanced kidney disease due for transplant listing, which has the advantages of obtaining both arteriography and venography using a single test without nephrotoxicity. KEY POINTS: • Evaluation of vascular disease is important in planning kidney transplantation. • Standard vascular imaging methods are often problematic in kidney disease patients. • FeMRA has the advantage of arteriography and venography in a single test. • FeMRA is safe and non-nephrotoxic. • FeMRA is not limited by arterial calcification.

Use of intravenous iron polymaltose in the management of iron deficiency in pregnancy: A retrospective cohort study.

BACKGROUND: Intravenous iron polymaltose (IPM) is commonly utilised in pregnancy when oral treatment is not tolerated or where rapid replenishment of iron stores is required, but data on use in pregnancy is scarce. AIM: To examine the use, safety and efficacy of intravenous IPM in pregnancy. METHODS: Retrospective cohort study of pregnant women administered intravenous IPM between January 2014 and January 2016 at a Tertiary teaching hospital in Adelaide, Australia. Data on maternal characteristics, intravenous iron infusion details, and haematological parameters were collected from case notes and electronic records. Main outcome measures included indication for intravenous iron infusion, prevalence of infusion reactions, change in haemoglobin and correction of anaemia prior to delivery. RESULTS: Intravenous IPM was administered in 213 pregnancies, 62.0% of women with iron deficiency anaemia (IDA) and the remainder (38.0%) with non-anaemic iron deficiency. Adverse drug reactions (ADRs) occurred in 24% of women, of which 32% required infusion cessation. Anaemia was still present at delivery among 7%, and 17% of women with mild, and moderate/severe anaemia respectively. Approximately one in five anaemic women received an intravenous IPM dose below that recommended by the local guideline, particularly in women with a body mass index ≥ 25 kg/m2 compared with <25 kg/m2 (30.9% vs 6.3%; P < 0.001). Doses 'at recommended' resulted in a greater increase in haemoglobin from treatment until delivery than doses 'below recommended' (adjusted beta coefficient 8.4 g/L; 95% CI 2.7-14.1 g/L). CONCLUSION: Intravenous IPM is effective in treating IDA in pregnancy but is associated with a high prevalence of ADRs and treatment cessation.

Phase III randomized trial comparing intravenous to oral iron in patients with cancer-related iron deficiency anemia not on erythropoiesis stimulating agents.

AIM: We aimed to find the optimal route of iron supplementation in patients with malignancy and iron deficiency (true or functional) anemia not receiving erythropoiesis stimulating agents (ESA). METHODS: Adult patients with malignancy requiring chemotherapy, hemoglobin (Hb) <12 g/dL and serum ferritin <100 mcg/mL, transferrin saturation <20% or hypochromic red blood cells >10% were randomized to intravenous (IV) iron sucrose or oral ferrous sulfate. The primary endpoint was change in Hb from baseline to 6 weeks. Secondary endpoints included blood transfusion, quality of life (QoL), toxicity, response and overall survival. RESULTS: A total of 192 patients were enrolled over 5 years: 98 on IV arm and 94 on oral arm. Median age was 51 years; over 95% patients had solid tumors. The mean absolute increase in Hb at 6 weeks was 0.11 g/dL (standard deviation [SD]: 1.48) in IV arm and -0.16 g/dL (SD: 1.36) in oral arm, P = 0.23. Twenty-three percent patients on IV iron and 18% patients on oral iron had a rise in Hb of ≥1 g/dL at 6 weeks, P = 0.45. Thirteen patients (13.3%) on the IV iron arm and 14 patients (14.9%) on the oral arm required blood transfusion, P = 1.0. Gastrointestinal toxicity (any grade) developed in 41% patients on IV iron and 44% patients on oral iron, P = 1.0. 5 patients on IV iron and none on oral iron had hypersensitivity, P = 0.06. QoL was not significantly different between the two arms. CONCLUSION: IV iron was not superior to oral iron in patients with malignancy on chemotherapy and iron deficiency anemia.

Safety and efficacy of intravenous iron polymaltose, iron sucrose and ferric carboxymaltose in pregnancy: A systematic review.

BACKGROUND: Intravenous (IV) iron in pregnancy is useful where oral iron is not tolerated or a rapid replenishment of iron is required. AIMS: To review the literature on the efficacy and safety of different IV iron preparations in the management of antenatal iron-deficiency anaemia (IDA). MATERIALS AND METHODS: We searched MEDLINE, Embase and Scopus from inception to June 2016. Eligible studies were randomised controlled trials (RCTs) and observational studies, involving administration of IV iron (ferric carboxymaltose (FCM), iron polymaltose (IPM) or iron sucrose (IS)), regardless of comparator, to manage antenatal IDA. Two independent reviewers selected studies, extracted data and assessed quality. RESULTS: A total of 47 studies were eligible (21 RCTs and 26 observational studies), investigating IS (n = 2635; 41 studies), FCM (n = 276; four studies) and IPM (n = 164; three studies). All IV preparations resulted in significant improvements in haematological parameters, with a median increase of 21.8 g/L at 3-4 weeks and 30.1 g/L by delivery, but there was no evidence of any associated improvements in clinical outcomes. A greater median increase in Hb was observed with a high (25 g/L; range: 20-39.6 g/L) compared with low dose (20 g/L; range: 6.2-50.3 g/L). The median prevalence of adverse drug reactions for IPM (2.2%; range: 0-4.5%) was lower than FCM (5.0%; range: 0-20%) and IS (6.7%; range: 0-19.5%). CONCLUSION: While IV iron in pregnancy improves haematological parameters, there is an absence of evidence for improvements in important maternal or perinatal outcomes. No single preparation of IV iron appeared to be superior, with the current IV iron preparation of choice largely determined by cost and convenience around administration.

Effect of conditioning solutions containing ferric chloride on dentin bond strength and collagen degradation.

OBJECTIVE: To investigate the effects of conditioning solutions containing ferric chloride (FeCl3) on resin-dentin bond strength; on protection of dentin collagen against enzymatic degradation and on cathepsin-K (CT-K) activity. METHODS: Conditioning solutions were prepared combining citric acid (CA) and anhydrous ferric chloride (FeCl3) in different concentrations. The solutions were applied to etch flat dentin surfaces followed by bonding with adhesive resin. Phosphoric acid (PA) gel etchant was used as control. The microtensile bond strength (µTBS) was tested after 24h of storage in water and after 9 months of storage in phosphate buffer saline. Dentin slabs were demineralized in 0.5M EDTA, pre-treated or not with FeCl3 and incubated with CT-K. The collagenase activity on dentin collagen matrix was examined and characterized by SEM. Additional demineralized dentin slabs were treated with the conditioning solutions, and the amount of Fe bound to collagen was determined by EDX. The activity of CT-K in the presence of FeCl3 was monitored fluorimetrically. Data were analyzed by ANOVA followed by post-hoc tests as required (α=5%). RESULTS: Slightly higher bond strengths were obtained when dentin was conditioned with 5% CA/0.6% FeCl3 and 5% CA-1.8%FeCl3 regardless of storage time. Bond strengths reduced significantly for all tested conditioners after 9 months of storage. Treating dentin with 1.8% FeCl3 was effective to preserve the structure of collagen against CT-K. EDX analysis revealed binding of Fe-ions to dentin collagen after 15s immersion of demineralized dentin slabs into FeCl3 solutions. FeCl3 at concentration of 0.08% was able to suppress CT-K activity. SIGNIFICANCE: This study shows that FeCl3 binds to collagen and offers protection against Cat-K degradation. Mixed solutions of CA and FeCl3 may be used as alternative to PA to etch dentin in resin-dentin bonding with the benefits of preventing collagen degradation.

Approaches for optimising intravenous iron dosing in pregnancy: a retrospective cohort study.

BACKGROUND: Intravenous iron is commonly utilised in pregnancy when treatment with oral is not tolerated or where rapid replenishment of iron stores is required. AIMS: To examine the relationship between doses of intravenous iron administered during pregnancy according to different maternal bodyweight measures and subsequent treatment response. METHODS: Retrospective cohort study of pregnant women with confirmed iron deficiency anaemia who received intravenous iron polymaltose at a tertiary teaching hospital in Australia from 1 January 2014 to 31 January 2016. Diagnosis of anaemia and/or iron deficiency, infusion dosage characteristics and haematological parameters were collected from paper-based case notes and electronic records. The dose of intravenous iron administered was examined relative to maternal total bodyweight (TBW), ideal bodyweight (IBW) (equation = 45.5 kg + 0.9 kg/cm for each cm over 152 cm) and adjusted bodyweight (equation = IBW + [0.4 × (TBW - IBW)]). RESULTS: A total of 122 pregnancies was identified where women had confirmed iron deficiency anaemia and received a single infusion of intravenous iron polymaltose. Dose-response relationships were evident between change in haemoglobin from treatment until delivery and intravenous iron dose according to adjusted bodyweight (adjusted beta coefficient 0.70 (95% CI 0.24-1.15)) and pre-pregnancy total bodyweight (adjusted beta coefficient 0.83 (95% CI 0.36-1.29)), but not ideal bodyweight (adjusted beta coefficient 0.37 (95% CI -0.04-0.78)). Calculating iron deficit using adjusted bodyweight most closely matched that based on a physiological estimate of iron deficit according to weight-based total blood volume. CONCLUSION: Optimal treatment outcomes in pregnant women requiring intravenous iron may be reached by dosing according to adjusted pre-pregnancy bodyweight rather than ideal bodyweight.

Iron Therapy Challenges for the Treatment of Nondialysis CKD Patients.

The clinical consequences of untreated, severe anemia in patients with nondialysis CKD can be significant, but disparities exist in the anemia treatment guidelines and position papers issued from working groups and associations across the world. These differ in hemoglobin target and iron levels and their emphasis on various iron markers and other clinical outcomes. Not surprisingly, disparities are observed in anemia treatment strategies among patients with nondialysis CKD across different areas of the world. Over the past decade, the prescription and dosage of both iron therapies and erythropoiesis-stimulating agents have shifted, with notable regional differences observed. Moreover, there is ongoing debate regarding oral versus intravenous administration of iron. Compared with oral iron therapy, which often leads to gastrointestinal adverse events, low patient adherence, and low efficacy, intravenous iron administration has been associated with potential serious adverse events, such as anaphylaxis. New iron-based compounds and drugs currently under development are reviewed to describe their potential benefits in the treatment of anemia in patients with CKD. New oral compounds, including iron-based phosphate binders, heme iron polypeptide, and liposomal iron, show different rates of absorption with possibly different efficacy and improved tolerability. These new potential therapies offer health care providers additional anemia treatment options for their patients with CKD; however, the management of anemia in the CKD population continues to present challenges that require prospective studies to identify the optimal iron therapy for patients.

Tratamento da anemia ferropriva com ferro por via oral: [revisão] / Treatment of iron deficiency anemia with oral iron: [review]

A anemia ferropriva permanece como uma das deficiências nutricionais mais frequentes e importantes no mundo. O tratamento com ferro deve ser iniciado preferencialmente por via oral e a investigação apropriada de sua causa é obrigatória. Os autores discutem os compostos com ferro atualmente disponíveis, o perfil de eficácia, segurança e tolerabilidade desses medicamentos, e o plano terapêutico mais adequado possível para o sucesso no tratamento dessa doença tão comum e importante.

Iron deficiency anemia remains one of the commonest and most important nutritional deficiencies in the world today. The treatment of iron deficiency should preferably be initiated with oral iron; an appropriate investigation of the cause of iron deficiency anemia is mandatory. The authors discuss the currently available iron preparations as well as their efficacy, safety and tolerability and the optimal therapeutic plan to successfully treat this common and important disease.

Tratamento da anemia ferropriva com ferro por via parenteral: [revisão] / Iron deficiency anemia treatment with parenteral iron: [review]

Embora o ferro por via oral seja considerado a primeira opção de tratamento da deficiência de ferro, em algumas situações específicas, a administração de ferro por via parenteral é uma opção terapêutica que deve ser considerada. Diferentemente do ferro dextran de alto peso molecular utilizado na década de 80 e lembrado como um composto associado ao alto risco de reação anafilática e morte, o desenvolvimento e comercialização de novos compostos com ferro para uso parenteral, sobretudo por via endovenosa - como o ferro sacarato, ferro gluconato e, mais recentemente, a carboximaltose férrica - , tem se tornado cada vez mais uma alternativa terapêutica segura e efetiva, e tem possibilitado ampliar o leque de indicações desta modalidade de tratamento além da nefrologia, como obstetrícia e ginecologia, cirurgia, pediatria, gastroenterologia, hematologia e hemoterapia. Os autores revisam as principais indicações do tratamento com ferro por via parenteral, analisam as principais drogas disponíveis para a correção da anemia ferropriva por via endovenosa e propõem uma estratégia de investigação diagnóstica, tratamento e seguimento laboratorial dos pacientes com indicação desta opção terapêutica.

Although oral iron is generally considered the first choice in the treatment of iron deficiency, in some specific situations, parenteral iron administration is a therapeutic option that should be considered. Different to the high-molecular-weight iron dextran utilized in the eighties and remembered as a compound associated with a high risk of anaphylaxis and death, the development and marketing of newer preparations for parenteral, in particular endovenous, administration, such as iron sucrose, ferric gluconate and more recently ferric carboxymaltose, are becoming a more effective and safe therapeutic alternative, that have extended the range of indications beyond nephrology to obstetrics and gynecology, surgery, pediatrics, gastroenterology, hematology and hemotherapy. The authors review the main indications of parenteral iron treatment, analyse the drugs available for the correction of iron deficiency anemia by intravenous iron administration and propose a new strategy of diagnostic investigation, treatment and laboratory follow up of the patient with indication for this therapeutic option.

Anemia ferropênica no adulto: causas, diagnóstico e tratamento: [revisão] / Iron deficiency anaemia in the adult: causes, diagnosis and treatment: [review]

A deficiência de ferro, especificamente a anemia ferropênica, permanece como uma das deficiências nutricionais mais frequentes e importantes no mundo. Este artigo revisa as principais causas de anemia ferropênica, os atuais métodos de investigação diagnóstica e as estratégias de prevenção. O tratamento com ferro deve ser iniciado sempre por via oral, e a investigação apropriada de sua causa é obrigatória; quando houver falha nesse tratamento por causa de grande perda de sangue, má absorção do ferro ou intolerância a ele, o tratamento por via parenteral deve ser considerado. Os autores discutem os compostos com ferro atualmente disponíveis, o perfil de eficácia, segurança e tolerabilidade desses medicamentos, e o plano terapêutico ideal para o sucesso no tratamento dessa doença tão comum e importante.

Iron deficiency, and especifically iron deficiency anaemia, remains one of the commonest and most important nutritional deficiencies in the world today. This article reviews the main causes of iron deficiency anaemia, the current diagnostic methods and prevention strategies of iron deficiency. The treatment of iron deficiency should always be initiated with oral iron and an investigation of the cause of iron deficiency anaemia is mandatory. When oral iron therapy fails due to high blood losses, iron malabsorption or intolerance to oral iron, parenteral iron administration should be considered. The authors discuss available iron preparations, their efficacy, safety and tolerability, and the optimal therapeutic approach to successfully treat this common and important disease.

Mechanisms of hemoglobin and its degradation products in brain edema formation after intracerebral hemorrhage / 国际脑血管病杂志

The peak of the brain edema after intracerebral hemorrhage usually begins after 3 to 4 days.A large quantity of hemoglobin releases and degrades during this process,and its degradation products iron ion,bilirubin and carbon monoxide,etc play important roles in the process of cerebral edema.They all involve in the formation Of delayed brain edema after intracerebral hemorrhage.The research of hemoglobin and its degradation products is expected to find out a new way for the treatment of intracerebral hemorrhage.