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Abstract: TH-PO674

The Effect of Intravenous Iron on Exercise Capacity in Iron-Deficient but Not Anaemic Patients With CKD: A Multicentre Prospective Double-Blind Randomised Controlled Trial

Session Information

  • Anemia and Iron Metabolism
    November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
    Abstract Time: 10:00 AM - 12:00 PM

Category: Anemia and Iron Metabolism

  • 200 Anemia and Iron Metabolism

Authors

  • Greenwood, Sharlene A., King's College Hospital NHS Foundation Trust, London, London, United Kingdom
  • Oliveira, Benjamin A., King's College London, London, London, United Kingdom
  • Asgari, Elham, Guy's and St Thomas' NHS Foundation Trust, London, London, United Kingdom
  • Ayis, Salma, King's College London, London, London, United Kingdom
  • Baker, Luke A., University of Leicester, Leicester, Leicestershire, United Kingdom
  • Banerjee, Debasish, St George's University Hospitals NHS Foundation Trust, London, London, United Kingdom
  • Bhandari, Sunil, Hull University Teaching Hospitals NHS Trust, Hull, Kingston upon Hull, United Kingdom
  • Chilcot, Joseph, King's College London, London, London, United Kingdom
  • Burton, James, University of Leicester, Leicester, Leicestershire, United Kingdom
  • Kalra, Philip A., Salford Royal Hospital, Salford, Salford, United Kingdom
  • Lightfoot, Courtney Jane, University of Leicester, Leicester, Leicestershire, United Kingdom
  • Macdougall, Iain C., King's College Hospital NHS Foundation Trust, London, London, United Kingdom
  • Mangelis, Anastasios, King's College London, London, London, United Kingdom
  • Mccafferty, Kieran, Royal London Hospital Cardiovascular Services, London, Greater London, United Kingdom
  • Okonko, Darlington, King's College London, London, London, United Kingdom
  • Reid, Fiona, King's College London, London, London, United Kingdom
  • Smith, Alice C., University of Leicester, Leicester, Leicestershire, United Kingdom
  • Swift, Pauline A., Epsom and Saint Helier University Hospitals NHS Trust, Carshalton, Sutton, United Kingdom
  • Watson, Emma L., University of Leicester, Leicester, Leicestershire, United Kingdom
  • Wheeler, David C., University College London, London, London, United Kingdom
  • Wilkinson, Thomas James, University of Leicester, Leicester, Leicestershire, United Kingdom
  • Bramham, Kate, King's College London, London, London, United Kingdom
Background

Many people living with chronic kidney disease (CKD) are iron deficient, even though they may not be anaemic. The Iron and Muscle study aimed to evaluate whether iron supplementation leads to enhanced exercise capacity and physical function.

Methods

Prospective, double-blind multicentre randomised controlled trial (RCT) with non-dialysis CKD patients with iron deficiency but without anaemia. Patients were randomly assigned (1:1) to either: i) intravenous (IV) iron therapy, or ii) placebo. Primary outcome was difference in six-minute walk test (6MWT) between groups at 4 weeks. Secondary outcomes included: fatigue, physical function, muscle strength, quality of life, clinical chemistry, safety and harms at baseline, 4, and 12 weeks. Difference in means for all outcomes between groups was analysed using an ANCOVA model.

Results

We randomly assigned 75 patients with mean (SD) age for iron therapy [(n=38) 54(16) yrs vs placebo (n=37) 61(12) yrs], mean (SD) eGFR [34(12) vs. 35(11) ml/min/1.73m2], mean (SD) transferrin saturation (TSAT) [23 (12) vs. 21 (6)%], mean (SD) serum ferritin (SF) [57 (64) vs. 62 (33) μg/L] and mean (SD) 6MWT [384 (195) vs. 469 (142) metres] at baseline, respectively. Adjusting for baseline measures, 6MWT showed no statistically significant difference between arms at 4 weeks (p=0.263), or 12 weeks (p=0.321). There were non-significant increases in 6MWT from baseline to 12 weeks in the IViron arm. There were statistically significant increases in SF and TSAT at 4 and 12 weeks (p<0.001) and haemoglobin at 12 weeks (p=0.0135). There were no adverse events attributable to IV iron.

Conclusion

This study did not demonstrate any significant beneficial effect of IV iron on exercise capacity despite improvements in parameters of iron status and Hb concentration, and numerical increases in functional capacity scores. A larger study is required to confirm if IV iron is beneficial in non-dialysis patients with CKD who are iron-deficient but not anaemic to improve exercise capacity.

Funding

  • Private Foundation Support