Safety and Efficacy of Iron Chelators in Patients With Chronic Kidney Disease: A Systematic Review and Meta‐Analysis

ABSTRACT Background Iron overload in chronic kidney disease contributes to oxidative injury. The role of iron chelators, standard in transfusion‐related overload, remains unclear in chronic kidney disease. Aim To evaluate the efficacy and safety of iron chelators in adults with chronic kidney disease. Methods A systematic review and meta‐analysis followed PRISMA 2020 guidelines. Databases were searched for randomized controlled trials and observational studies reporting on iron indices, hematological parameters, and adverse events. Results Eleven studies (206 patients) were included. Iron chelation significantly reduced serum ferritin (weighted mean difference [WMD]: −1.48 μg/L; 95% CI: −2.09, −0.87), transferrin (WMD: −10.6 mg/dL; 95% CI: −15.6, −5.61), and serum iron (WMD: −24.2 μg/dL; 95% CI: −42.5, −5.9). Hemoglobin increased (WMD: 1.07 g/dL; 95% CI: 0.20, 1.94). Glucose levels decreased, but lipid parameters were unaffected. Evidence was limited by high heterogeneity and potential bias. Gastrointestinal adverse events were common; serious events were rare. Conclusion Iron chelation effectively reduces iron stores and may improve anemia in chronic kidney disease patients. However, the evidence is limited by small sample sizes and heterogeneity. High‐quality randomized controlled trials are needed to establish clinical utility and safety before routine use.