Iron Therapy in Peritoneal Dialysis: A Systematic Review and Meta-Analysis with Insights from a National Questionnaire Survey

Abstract1.1 Background and ObjectivesAnaemia and iron deficiency are common in people undergoing peritoneal dialysis (PD), contributing to increased morbidity and mortality. While oral iron is often used due to its accessibility, it may be poorly tolerated or insufficient. Intravenous (IV) iron offers advantages such as superior haemoglobin responses and reduced erythropoiesis-stimulating agent requirements. However, its safety and efficacy in PD remain unclear, with significant variability in prescribing practices reflecting evidence gaps and limited data on long-term outcomes. This study systematically reviews evidence on IV iron for managing anaemia in PD and evaluates UK clinical practices to inform future research.1.2 MethodsA systematic review assessed randomised, quasi-randomised trials and cohort studies evaluating IV iron in adults undergoing PD, focusing on changes in iron status, anaemia management, and adverse events. A cross-sectional survey of UK kidney clinicians (n=41) explored iron repletion strategies, diagnostic thresholds, and barriers to therapy. Responses were analysed using descriptive and thematic approaches.1.3 ResultsThe review identified heterogeneity in study designs, populations, and outcomes. Intravenous iron consistently improved ferritin, transferrin saturation (TSAT), haemoglobin, and haematocrit levels with few reported adverse events. The survey revealed most UK clinicians (65.9%) prefer high-dose IV iron (≥500 mg/visit) and initiating therapy when ferritin is <200 μg/L (53.7%) or TSAT <20% (78.1%). Diagnostic measures like reticulocyte haemoglobin content were rarely used (14.6%). Safety concerns led 90.2% to withhold iron during active infections, with trial eligibility estimates indicating 6–10% of patients might not meet inclusion criteria due to elevated C-related peptide, ferritin, or TSAT.1.4 ConclusionsIntravenous iron shows promise in improving anaemia biomarkers for people receiving PD, but variability in practice and methodological limitations in evidence necessitate caution. A robust randomised controlled trial is urgently needed to establish optimal iron dosing, safety, and impacts beyond anaemia, such as cardiovascular health and quality of life, to guide standardised and effective care.