Can oral iron supplementation be used to treat low Transferrin Saturation (TSAT)?

From the Guidelines

Oral iron supplementation can be used to treat low Transferrin Saturation (TSAT), but it is unlikely to maintain adequate iron status, especially in adult CKD, home hemodialysis, and peritoneal dialysis patients. According to the guidelines, if oral iron is given, it should be administered at a daily dose of at least 200 mg of elemental iron for adults and 2 to 3 mg/kg for pediatric patients 1. However, a trial of oral iron is acceptable in the hemodialysis patient, but it is unlikely to maintain the TSAT < 20%, serum ferritin < 100 ng/mL, and Hgb/Hct at 33% to 36%/11 to 12 g/dL 1.

Some key points to consider when using oral iron supplementation include:

• The adult CKD, home hemodialysis, and peritoneal dialysis patient may not be able to maintain adequate iron status with oral iron 1
• Intravenous iron can be given on a variety of dosage schedules, and most hemodialysis patients will require intravenous iron on a regular basis to achieve and maintain an Hgb 11 to 12 g/dL (Hct of 33% to 36%) 1
• Oral iron is not indicated for the CKD, according to some guidelines, but a trial of oral iron can be acceptable in certain cases 1

It is essential to monitor the patient's iron parameters, including TSAT and serum ferritin, regularly to determine the effectiveness of oral iron supplementation and to adjust the treatment plan as needed 1. Additionally, patients should be informed about the potential side effects of oral iron supplementation, such as constipation, nausea, and black stools. In general, oral iron supplementation can be used to treat low TSAT, but it is crucial to carefully evaluate the patient's individual needs and response to treatment.

From the Research

Oral Iron Supplementation for Low Transferrin Saturation (TSAT)

• Oral iron supplementation can be used to treat iron deficiency anemia, but its effectiveness in treating low TSAT is not directly addressed in the provided studies 2, 3, 4, 5, 6.
• However, study 6 compares the effect of ferric citrate versus ferrous sulfate on iron and phosphate parameters in patients with iron deficiency and chronic kidney disease (CKD), and finds that ferric citrate results in a greater increase in TSAT and ferritin concentrations.
• Another study 5 compares the efficacy and safety of intravenous ferric carboxymaltose versus oral iron in patients with iron-deficiency anemia resulting from gastrointestinal disorders, and finds that intravenous ferric carboxymaltose is more effective in increasing hemoglobin levels.
• Study 4 discusses the role of ferric carboxymaltose in the treatment of iron deficiency anemia in patients with gastrointestinal disease, and suggests that it should be considered as first-line therapy in patients with active inflammation or inadequate response to oral iron therapy.
• Overall, while oral iron supplementation can be used to treat iron deficiency anemia, intravenous iron therapy may be more effective in certain cases, such as gastrointestinal disorders or CKD 2, 3, 4, 5.

Key Findings

• Ferric citrate results in a greater increase in TSAT and ferritin concentrations compared to ferrous sulfate in patients with iron deficiency and CKD 6.
• Intravenous ferric carboxymaltose is more effective in increasing hemoglobin levels compared to oral iron in patients with iron-deficiency anemia resulting from gastrointestinal disorders 5.
• Ferric carboxymaltose should be considered as first-line therapy in patients with active inflammation or inadequate response to oral iron therapy 4.