Effectiveness of Erythropoiesis-Stimulating Agent Therapy with Oral and Intravenous Iron Supplementation in Achieving Hemoglobin Targets in Stage 5 Chronic Kidney Disease Patients

Background: Chronic kidney disease (CKD) is a major global health burden that is frequently accompanied by anemia due to erythropoietin deficiency and impaired iron metabolism, contributing to increased morbidity and reduced quality of life. Standard anemia management involves a combination of erythropoiesis-stimulating agents (ESAs) and iron supplementation administered either orally or intravenously. Differences in the route of iron administration may influence the effectiveness of hemoglobin (Hb) improvement. Objective: To evaluate the effectiveness of anemia therapy based on hemoglobin target achievement between ESA combined with oral iron supplementation and ESA combined with intravenous iron supplementation in patients with stage 5 CKD. Methods: This study employed a retrospective cohort observational analytic design using patients’ medical record data. A total of 186 patients were included in the study. Therapeutic effectiveness was assessed based on the achievement of an Hb increase of ≥1 g/dL within three months of therapy. Results: Baseline characteristics were comparable between the two groups, including sex (p = 0.797), age (p = 0.124), and severity of anemia (p = 0.145). The proportion of patients achieving the target Hb increase was significantly higher in the ESA plus intravenous iron group than in the ESA plus oral iron group (66.20% vs. 39.13%; p = 0.001). Mean Hb levels increased from 7.83 ± 1.37 g/dL to 8.35 ± 1.41 g/dL in the ESA plus oral iron group (ΔHb: 0.52 ± 1.38 g/dL) and from 8.00 ± 1.57 g/dL to 8.86 ± 1.32 g/dL in the ESA plus intravenous iron group (ΔHb: 0.86 ± 1.24 g/dL), although the difference in mean Hb change between groups was not statistically significant (p = 0.073). Conclusion: ESA therapy combined with intravenous iron supplementation was more effective in achieving the target hemoglobin level than ESA therapy combined with oral iron supplementation in patients with stage 5 CKD.