Iron Therapy for Anemia in Diverse Populations: An Umbrella Review of Systematic Reviews

Elmukhtar Habas, Aml Habas, Hafedh Ghazouani, Ala Habas, Eshrak Habas, Amnna Rayani

Keywords: Iron therapy, intravenous iron, oral iron, anemia, dialysis, iron deficiency anemia, CKD, AKI, kidney transplantation

DOI: 10.63475/yjm.v5i1.0296

DOI URL: https://doi.org/10.63475/yjm.v5i1.0296

Publish Date: 07-04-2026

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Author Affiliation:

1 Professor of Internal Medicine, Qatar University, Hamad General Hospital (HGH), Doha, Qatar
2 Specialist Hematology, University Children’s Hospital, Tripoli, Libya
3 Quality and Patient Reviewer, Corporate Quality Improvement and Patient Safety Department, Hamad Medical Corporation (HMC), Doha, Qatar
4 Resident, Tripoli Central Hospital, University of Tripoli, Tripoli, Libya
5 Resident, University of Tripoli, Tripoli, Libya
6 Professor, University of Tripoli, Tripoli, Libya

Abstract

Iron deficiency anemia is a common condition seen in several demographics, including the general population, those with chronic kidney disease (CKD), those with acute kidney injury (AKI), patients dependent on dialysis, and kidney transplant recipients. This umbrella review synthesizes data only from published systematic reviews and meta-analyses to evaluate the efficacy and safety of iron therapy for chronic and acute anemia in these populations. The evaluation compared intravenous (IV) and oral iron supplementation, concentrating on hemoglobin response, cardiovascular outcomes, and related comorbidities. Data from 45 systematic reviews and meta-analyses demonstrate that in the general population, alternate-day oral iron has equivalent efficacy to daily dosing, while resulting in fewer adverse effects. The evidence for iron therapy in AKI is limited and suggests potential negative consequences from supplementation, while chelation may provide therapeutic benefits. Still, high-quality data on AKI are lacking. IV iron is often more efficacious than oral iron in elevating Hb levels, particularly in patients with CKD and those receiving dialysis, with risk ratios for achieving target Hb levels ranging from 1.23 to 1.71. Iron supplementation after transplantation enhances anemia; nonetheless, appropriate procedures remain undetermined. In terms of safety, IV presents a risk of hypersensitive reactions (relative risk [RR], 3.56 [95% CI, 1.88–6.74]) in contrast to oral iron. However, the absolute risk with modern formulations is low (0.1%–0.5%). Conversely, oral iron is linked to gastrointestinal side effects; IV iron reduces gastrointestinal events by 53% compared to oral iron (RR, 0.47 [95% CI, 0.33–0.66]). IV iron decreases hospitalizations for heart failure (RR, 0.77) in CKD, while it may increase the risk of serious adverse events under certain conditions. Therefore, it can be concluded that there is a need for personalized iron therapy to improve both efficacy and safety. Future research should prioritize high-quality trials in AKI and standardized protocols in transplantation.

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