Role of Parenteral Iron Therapy in Chronic Kidney Disease Patients

Objective: To compare the effectiveness of intravenous (IV) versus oral iron therapy in improving hematologic parameters in chronic kidney disease (CKD) patients. Methods: This prospective cohort study was conducted in the Nephrology Department of Jinnah Postgraduate Medical Centre, Karachi, Pakistan, from June to September 2025. Adults aged 18–60 years with CKD were enrolled and equally divided into two groups. Participants received either IV iron sucrose (200 mg infused over 60–90 minutes) or oral iron (325 mg thrice daily) as determined by the treating clinician’s judgment and routine care practice. Baseline and post-treatment measurements of hemoglobin, serum iron, ferritin, transferrin, and total iron-binding capacity (TIBC) were compared between groups. Results: Of the total 120 patients, the median age was 41 years (28–53). All laboratory parameters showed significant improvement after four weeks of iron therapy in both groups (all p-values < 0.001). Within-group analysis showed significant increases in hemoglobin, serum iron, ferritin, transferrin, and TIBC for both IV and oral therapy (all p-values < 0.001). Post-treatment comparison showed that hemoglobin (p-value = 0.013), serum iron, ferritin, transferrin, and TIBC (all p-values < 0.001) were significantly higher in the IV group compared to the oral group. Adverse events were reported in 66 (55.0%) participants, with 35 (53.0%) in the IV group and 31 (47.0%) in the oral group. Conclusion: IV and oral iron both improved hematologic parameters in CKD patients, with greater improvement observed in the IV group; adverse events were almost similar between groups.