ferrous-citrate and Anemia--Iron-Deficiency

Oral iron preparations are used as first-line treatment for iron deficiency anemia (IDA), but their gastrointestinal side effects prevent patients from appropriate adherence. We recently conducted a randomized, double-blind, phase 3 non-inferiority study to evaluate the efficacy and safety of two dosages of ferric citrate hydrate (FC) compared with sodium ferrous citrate (SF) in patients with IDA. FC at both 500 and 1000 mg/day was non-inferior to SF at 100 mg/day in terms of the change in the hemoglobin concentration at Week 7 from baseline. Logistic regression analysis suggested that the cumulative proportion of patients who achieved the target hemoglobin concentration (≥ 13.0 g/dL in male patients and ≥ 12.0 g/dL in female patients) at Week 7 was highest among those treated with FC at 1000 mg/day, followed by SF at 100 mg/day and FC at 500 mg/day. Both dosages of FC were well tolerated in patients with IDA. The incidences of nausea and vomiting were significantly lower in the FC treatment groups than in the SF group. In conclusion, FC has potential to be an oral iron preparation with sufficient efficacy for the treatment of IDA and a lower risk of nausea and vomiting.

Topics: Adult; Anemia, Iron-Deficiency; Citric Acid; Double-Blind Method; Ferric Compounds; Ferrous Compounds; Humans; Japan; Middle Aged; Treatment Outcome

Iron administration affects serum levels of intact (I-) fibroblast growth factor-23 (FGF23) and its cleavage product C-terminal (C-) FGF23 in iron-deficient patients on maintenance hemodialysis (MHD). The objective of this study was to compare the effect of oral or intravenous iron administration on serum levels of I-FGF23 and C-FGF23 in iron-deficient patients on MHD.. A prospective randomized study.. Participants on MHD with severe iron deficiency (n = 61).. Participants were randomized to receive oral iron (50 mg of sodium ferrous citrate daily; oral group, n = 29) or intravenous iron (40 mg of saccharated ferric oxide weekly; IV group, n = 32).. Changes in I-FGF23 and C-FGF23 after 10 weeks of treatment.. Iron supplementation significantly increased hemoglobin, mean corpuscular volume, ferritin, and transferrin saturation rate, and decreased erythropoiesis-stimulating agent dose and erythropoiesis-stimulating agent resistance index value. Serum phosphate, calcium, and intact parathyroid hormone levels did not change significantly during the study. I-FGF23 levels increased significantly in the IV group and did not change in the oral group, whereas C-FGF23 levels were significantly reduced in both groups. Serum interleukin-6 and tumor necrosis factor-α levels were increased in both groups. Multiple regression analysis indicated the relationship between iron or erythropoiesis and FGF23 metabolism.. Iron administration to patients on MHD with severe iron deficiency decreased C-FGF23 levels, whereas intravenous iron increased I-FGF23 levels though oral iron did not. If the target of chronic kidney disease-mineral and bone disorder therapy is reducing I-FGF23 levels, we suggest the use of oral iron.

Topics: Administration, Intravenous; Administration, Oral; Aged; Anemia, Iron-Deficiency; Citric Acid; Dietary Supplements; Female; Ferric Oxide, Saccharated; Ferrous Compounds; Fibroblast Growth Factor-23; Fibroblast Growth Factors; Humans; Male; Prospective Studies; Renal Dialysis; Renal Insufficiency, Chronic; Treatment Outcome

A 52-year-old man who had been taking omeprazole, a proton pump inhibitor (PPI), for 25 years developed iron deficiency anemia. An evaluation of the entire gastrointestinal tract did not reveal any possible causes of gastrointestinal blood loss. The cause of the iron deficiency was considered to be a reduction in gastrointestinal iron absorption in association with the reduced secretion of gastric acid due to PPI use. This case demonstrates that long-term PPI use for as long as 25 years may cause iron deficiency anemia and should be considered in the differential diagnosis of iron deficiency anemia in long-term PPI users.

Topics: Anemia, Iron-Deficiency; Citric Acid; Ferrous Compounds; Humans; Iron; Iron Deficiencies; Japan; Male; Middle Aged; Omeprazole; Proton Pump Inhibitors; Time Factors; Treatment Outcome

Objective Iron deficiency anemia (IDA) has become important with regard to mortality in hemodialysis (HD) patients. Therefore, it is necessary to optimize the treatment of these patients. Methods IDA in end-stage renal disease patients on HD was observed in 42 (33.6%) of 125 patients. We examined the influence of daily orally iron [sodium ferrous citrate (SFC) iron/tablet 50 mg, 1-2 tablets] on the renal function markers, anemia and iron data for about 6 months. Results The hematocrit and hemoglobin levels were significantly increased in the patients treated with SFC [hematocrit: before 28.5%±2.1% (mean ± standard deviation), 1st month 30.0%±2.3%, p<0.05; 3rd month 32.4%±2.9%, p<0.05; 6th month 31.3%±3.4%, p<0.05; and hemoglobin: before 9.25±0.70, 1st month 9.72±0.71, p<0.05; 3rd month 10.54±0.96, p<0.05; 6th month 10.25±1.21 g/dL, p<0.05]. The transferrin saturation (TSAT) and serum ferritin levels were significantly increased in the patients treated with SFC (TSAT: before 21.5%±10.0%, 1st-3rd month, 34.1%±15.1%, p<0.05; 6-8th month 34.7%±11.9%, p<0.05; and ferritin: before 38.2±37.1, 6-8th month 67.5±44.0 ng/mL, p<0.05). The present findings clearly indicate that oral iron is an effective route of iron supplementation in HD patients, and no adverse effects associated with SFC occurred during the treatment and follow-up period. Conclusion Our results clearly indicate that oral iron delivered via SFC is a well-tolerated and effective form of iron supplementation in long-term HD and IDA patients in Japan.

Topics: Aged; Aged, 80 and over; Anemia, Iron-Deficiency; Biomarkers; Citric Acid; Erythropoietin; Female; Ferritins; Ferrous Compounds; Hematocrit; Hemoglobins; Humans; Iron; Japan; Kidney Failure, Chronic; Male; Middle Aged; Renal Dialysis; Transferrin

Iron deficiency anemia is an important public health issue, especially for infants, children, and women with menorrhagia. Oral iron supplements are the cheapest, safest, and most effective treatment. This study compared the therapeutic and side effects of ferrous and ferric in iron deficiency anemia.. This was a retrospective study on data collected between April 2012 and October 2013 for patients with iron deficiency anemia who continuously took oral ferric for over one month and then switched to oral ferrous due to poor therapeutic effects. The exclusion criteria were the use of other oral or injected iron preparations, erythropoietin, or vitamin B12.. A total of 41 participants were recruited. The average participant age was 44.76±16.89 years; most participants were females (95.1%; 39/41); the average daily dose of oral ferric (139.02±49.39 mg) was higher than that of ferrous (96.34±23.43 mg). Repeated measures: mixed model analyses were conducted to examine patients' clinical blood test values. The results showed that the mean blood test values for all patients significantly increased after switching to ferrous (p<0.01, with the exception of mean corpuscular hemoglobin). One patient experienced gastrointestinal discomfort and diarrhea after switching to ferrous.. This study found that blood test values improved after iron deficiency anemia female patients who displayed poor therapeutic effects with oral ferric switched to ferrous. Literature review showed that the risk for gastrointestinal problems with ferrous is higher than that with ferric. However, no significant difference was found in this study.

Topics: Administration, Oral; Adult; Anemia, Iron-Deficiency; Citric Acid; Dietary Supplements; Female; Ferric Compounds; Ferrous Compounds; Hematinics; Hemoglobins; Humans; Male; Middle Aged; Retrospective Studies; Tablets; Taiwan; Treatment Outcome

Recent studies on iron metabolism have begun to reveal the molecular mechanisms underlying iron absorption, which is dramatically affected in several disorders. In the clinical setting, the ability to determine the status of iron absorption would aid in the diagnosis of pathological conditions. Efforts to develop an oral iron absorption test (OIAT) date back to at least 60 years. However, previous procedures were associated with a number of problems, such as radiation exposure and low reproducibility. In an attempt to resolve these issues, we employed sodium ferrous citrate (SFC), by which the influence of various nutrients and drugs on iron absorption was markedly reduced. We found that OIAT using SFC was simple to perform in both hospitalized patients and outpatients. The increment of serum iron and % transferrin saturation at 120 min after SFC administration was useful in distinguishing iron absorption between healthy volunteers, patients with iron-deficiency anemia, and patients with anemia secondary to chronic disorders, which are respectively characterized by normal, enhanced, and reduced iron absorption. Thus, the SFC-based OIAT may represent a viable screening test for the evaluation of gastrointestinal iron absorption.

Topics: Adult; Anemia, Iron-Deficiency; Blood Chemical Analysis; Chronic Disease; Citric Acid; Female; Ferrous Compounds; Gastrointestinal Tract; Humans; Intestinal Absorption; Iron; Male; Middle Aged; Young Adult

Topics: Anemia; Anemia, Hypochromic; Anemia, Iron-Deficiency; Calcium; Calcium Citrate; Citrates; Citric Acid; Drug Therapy; Ferrous Compounds; Iron

Topics: Anemia; Anemia, Hypochromic; Anemia, Iron-Deficiency; Calcium Citrate; Citric Acid; Ferrous Compounds; Iron; Iron, Dietary; Pregnancy; Pregnancy Complications