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Abstract: TH-PO986

Effect of Multiple Doses per Day vs. Daily vs. Alternate Day Oral Iron Therapy in Iron Deficiency Anemia with CKD

Session Information

Category: Anemia and Iron Metabolism

  • 200 Anemia and Iron Metabolism


  • Patel, Nilang G., Virginia Commonwealth University, Richmond, Virginia, United States
  • Silvey, Scott, Virginia Commonwealth University, Richmond, Virginia, United States
  • Arora, Pradeep, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, United States

We investigated the effect of 2-3 times a day (typical clinical practice) vs. once-a-day vs. alternate-day oral iron administration on the improvement of Hgb and iron indices in patients with Iron deficiency anemia (IDA) & CKD.


Retrospective observational study of the veterans with IDA [defined as Hgb < 12 g/dL and either 1.) iron saturation < 20% or 2.) ferritin < 50 micrograms/L] and CKD [defined by eGFR < 60 ml/min/1.73m2] who received the first index outpatient prescription of oral iron for 90 days with one additional refill within 120 days from 2009-2019. Patient were classified into three groups: daily (once-a-day), multi-doses per day (> = 2-3 times per day) and alternate-day dose based on their oral iron dosing schedule. Groups were analyzed with longitudinal mixed effects models to estimate mean improvement (change-from-baseline) in Hgb & iron indices over the course of the time.


25,882 veterans were included in final cohort.Table 1 shows baseline characteristics & change in Hgb & iron indices at 90 & 210 days. Figure 1 shows estimated Hgb improvement in different groups. Hgb & iron indices significantly improved in multi-dose iron group compared to the daily group. Alternate day group showed slower pace of improvement in Hgb & iron indices. After adjusting all covariates, it did not affect the final results.


All different oral iron strategy improves Hgb & iron indices over time, although, multi-dose per day strategy improves at a much faster pace. The choice of oral iron therapy should depend on the rapidity of response desired, & patient preference due to adverse effects.

Table 1: Baseline Characteristics and Outcomes