Anaemia is a common clinical symptom characterised by a decrease in the peripheral blood red cell volume below the lower limit of normal. Iron deficiency is a prevalent cause of anaemia, and various factors cause iron deficiency anaemia [17,18,19]. Regardless of the cause, the mainstay of treatment for anaemia involves iron supplementation. Due to insufficient understanding of intravenous iron preparations and the past high incidence of intravenous iron-induced ADRs, these preparations have limited use.
Ferrous succinate tablets are commonly used oral iron preparations in the current market, primarily indicated for iron deficiency anaemia of various origins, including chronic bleeding, pregnancy, malnutrition and developmental issues during childhood. Evidence has shown that oral ferrous succinate tablets can significantly correct iron deficiency anaemia [20]. Iron sucrose is a complex with an average molecular weight of 43 kDa, comprised of a multi-nuclear iron (III) hydroxide core surrounded by non-covalently bound sucrose molecules. This large molecular structure prevents renal elimination and remains stable, with no release of iron ions under physiological conditions.
This study retrospectively collected clinical data from 374 patients with iron deficiency anaemia admitted to our hospital between 1 January and 31 December 2020 via the convenience sampling method. In terms of clinical efficacy, this study included 312 patients from special populations: 121 individuals with impaired renal function (including those undergoing haemodialysis), 57 children and adolescents, 21 pregnant women and 113 elderly individuals (excluding those with impaired renal function). In comparison with those using ferrous succinate tablets, iron sucrose users exhibited superior treatment outcomes, consistent with the findings reported by previous studies [21]. Moreover, approximately 30% of patients in each group had chronic kidney disease and cancer, which are well-known obstacles to intestinal iron absorption due to inflammation. This explains why the intravenous form is more effective. Notably, 101 patients with impaired renal function included in this study were diagnosed with chronic kidney failure, with the majority experiencing renal anaemia. In groups A and B, there were 46 and 45 patients with chronic kidney failure, respectively, all of whom received concurrent erythropoiesis-stimulating agents. Iron deficiency in renal anaemia not only exacerbates the severity of anaemia but also affects the effectiveness of erythropoietin. Following effective iron supplementation, the dosage of erythropoiesis-stimulating agents in both groups decreased compared with before treatment. The comparison of efficacy between the 2 groups indicates that intravenous iron supplementation can promptly and effectively replenish the iron required by patients with renal anaemia. It can also improve their condition safely and enhance the effect of erythropoiesis-stimulating agents using a reduced dosage.
Our results suggest that patients with chronic kidney disease and cancer benefit more from intravenous iron therapy than from oral iron therapy. This finding is consistent with reports in the literature that intestinal iron absorption is impaired in chronic inflammatory states [21,22,23]. Intravenous iron has been shown to have a higher efficacy in these patient groups due to its direct access to the bloodstream, bypassing the intestinal absorption step. In addition, the use of intravenous iron may also reduce gastrointestinal irritation, which is particularly important for patients with impaired gastrointestinal function. Therefore, our study emphasizes the need to consider the patient’s specific pathological status when formulating clinical treatment strategies, and may require personalized treatment plans for patients with chronic kidney disease and cancer.
Iron sucrose-induced ADRs include metallic taste [22], headaches [23], nausea [24] and vomiting [25]. The incidence rates of these reactions are generally low. In this study, no severe ADRs were observed in either group, and no significant statistical differences were found between the groups. Among the 31 patients who experienced ADRs, damage to the skin and its appendages, the administration site and the gastrointestinal system ranked among the top three in terms of ADRs affecting systemic organs. Phlebitis at the administration site had the highest incidence rate among ADRs related to iron sucrose injection, occurring in 5 cases (33.33%). Previous research data shows that the incidence of phlebitis following intravenous injection of iron sucrose is approximately 11.1–50%, which is related to the number of injections. This might be because iron sucrose injection is a complex solution of multi-nuclear iron (III)-sucrose, which, upon entering the body through intravenous administration, dissociates into sucrose and iron in the reticuloendothelial system. This dissociation potentially stimulates local blood vessels [26], thereby elevating the risk of phlebitis during intravenous infusion [27, 28].
This study has certain limitations. First, it is a retrospective analysis, which may result in deficiencies in patient inclusion criteria, clinical data selection and data processing. Second, the study is confined to patients treated at our hospital, potentially introducing bias to the results. Further research with an expanded sample size is recommended for a more comprehensive investigation and data refinement and to provide more accurate real-world evidence for the effective prevention of ADRs. In addition, inflammatory markers were not collected in this paper, which is a limitation of this study. In further studies, we will collect inflammatory markers for subgroup analysis to evaluate their impact on the efficacy of iron supplementation.
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