Kidney Week

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

Sharlene A. Greenwood,

• Oliveira, Benjamin A., King's College London, London, London, United Kingdom

Benjamin A. Oliveira,

• Asgari, Elham, Guy's and St Thomas' NHS Foundation Trust, London, London, United Kingdom

Elham Asgari,

• Ayis, Salma, King's College London, London, London, United Kingdom

Salma Ayis,

• Baker, Luke A., University of Leicester, Leicester, Leicestershire, United Kingdom

Luke A. Baker,

• Banerjee, Debasish, St George's University Hospitals NHS Foundation Trust, London, London, United Kingdom

Debasish Banerjee,

• Bhandari, Sunil, Hull University Teaching Hospitals NHS Trust, Hull, Kingston upon Hull, United Kingdom

Sunil Bhandari,

• Chilcot, Joseph, King's College London, London, London, United Kingdom

Joseph Chilcot,

• Burton, James, University of Leicester, Leicester, Leicestershire, United Kingdom

James Burton,

• Kalra, Philip A., Salford Royal Hospital, Salford, Salford, United Kingdom

Philip A. Kalra,

• Lightfoot, Courtney Jane, University of Leicester, Leicester, Leicestershire, United Kingdom

Courtney Jane Lightfoot,

• Macdougall, Iain C., King's College Hospital NHS Foundation Trust, London, London, United Kingdom

Iain C. Macdougall,

• Mangelis, Anastasios, King's College London, London, London, United Kingdom

Anastasios Mangelis,

• Mccafferty, Kieran, Royal London Hospital Cardiovascular Services, London, Greater London, United Kingdom

Kieran Mccafferty,

• Okonko, Darlington, King's College London, London, London, United Kingdom

Darlington Okonko,

• Reid, Fiona, King's College London, London, London, United Kingdom

Fiona Reid,

• Smith, Alice C., University of Leicester, Leicester, Leicestershire, United Kingdom

Alice C. Smith,

• Swift, Pauline A., Epsom and Saint Helier University Hospitals NHS Trust, Carshalton, Sutton, United Kingdom

Pauline A. Swift,

• Watson, Emma L., University of Leicester, Leicester, Leicestershire, United Kingdom

Emma L. Watson,

• Wheeler, David C., University College London, London, London, United Kingdom

David C. Wheeler,

• Wilkinson, Thomas James, University of Leicester, Leicester, Leicestershire, United Kingdom

Thomas James Wilkinson,

• Bramham, Kate, King's College London, London, London, United Kingdom

Kate Bramham,

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