Comparative Study of Oral vs. Intravenous Iron Supplements in the Management of Anemia in Chronic Kidney Disease

Aim: The study aimed to compare the efficacy, safety, and tolerability of oral and intravenous (IV) iron supplementation in the management of anemia in chronic kidney disease (CKD) patients. Materials and Methods: This prospective, randomized, comparative clinical trial was conducted at a tertiary care hospital, enrolling 120 adult patients with CKD-associated anemia. Patients were randomly assigned to either the oral iron group (n=60), receiving ferrous sulfate 200 mg twice daily for 12 weeks, or the IV iron group (n=60), receiving IV iron sucrose 200 mg weekly for five doses. Hemoglobin (Hb), serum ferritin, and transferrin saturation (TSAT) levels were measured at baseline, week 4, week 8, and week 12. Adverse events, including gastrointestinal symptoms in the oral group and infusion reactions in the IV group, were recorded. Statistical analysis was performed using SPSS, with a significance level of p < 0.05. Results: At week 12, the IV iron group showed a significantly greater increase in Hb (11.35 ± 0.93 g/dL) compared to the oral iron group (10.75 ± 0.95 g/dL, p < 0.001). Ferritin levels also increased more in the IV iron group (480.75 ± 80.40 ng/mL vs. 225.40 ± 55.25 ng/mL, p < 0.001), along with TSAT (38.90 ± 6.50% vs. 24.50 ± 5.40%, p < 0.001). Gastrointestinal side effects were reported in 16 (26.67%) patients in the oral iron group, while infusion reactions were observed in 9 (15.00%) patients receiving IV iron (p < 0.001). Multiple regression analysis identified IV iron therapy as the strongest predictor of hemoglobin improvement (β = 0.40, p < 0.001), while diabetes mellitus negatively impacted hemoglobin response (β = -0.12, p = 0.038). Conclusion: IV iron supplementation was more effective than oral iron in improving hemoglobin levels, ferritin, and TSAT in CKD patients with anemia. While oral iron was associated with gastrointestinal side effects, IV iron therapy had a higher incidence of infusion-related reactions. Given its superior efficacy, IV iron should be the preferred treatment for patients requiring rapid and effective anemia correction, particularly in moderate to severe CKD cases.