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Tratamiento con hierro en pacientes adultos anémicos sin nefropatías crónicas

Appendices

Appendix 1. Search strategies

Cochrane Central Register of Controlled Trials

#1 MeSH descriptor Iron Compounds explode all trees
#2 MeSH descriptor Ferric Compounds explode all trees
#3 MeSH descriptor Ferrous Compounds explode all trees
#4 iron OR ferrous OR ferric
#5 (#1 OR #2 OR #3 OR #4)
#6 MeSH descriptor Anemia explode all trees
#7 anemi* OR anaemi*
#8 (#6 OR #7)
#9 (#5 AND #8)

PubMed

("Iron Compounds"[Mesh] OR "Ferric Compounds"[Mesh] OR "Ferrous Compounds"[Mesh] OR iron OR ferrous OR ferric) AND ("Anemia"[Mesh] OR anemi* OR anaemi*) AND ((randomized controlled trial [pt] OR controlled clinical trial [pt] OR randomized [tiab] OR placebo [tiab] OR drug therapy [sh] OR randomly [tiab] OR trial [tiab] OR groups [tiab]) NOT (animals [mh] NOT humans [mh]))

EMBASE (Ovid SP)

1 exp iron therapy/
2 (iron or ferrous or ferric).af.
3 1 or 2
4 exp anemia/
5 (anemi* OR anaemi*).af.
6 4 or 5
7 exp crossover‐procedure/ or exp double‐blind procedure/ or exp randomized controlled trial/ or single‐blind procedure/
8 (random* or factorial* or crossover* or placebo*).af.
9 7 or 8
10 3 and 6 and 9

ISI Web of Science: Science Citation Index‐Expanded (SCI‐EXPANDED) and Conference Proceedings Citation Index‐Science (CPCI‐S)

# 1 TS=(iron OR ferrous OR ferric)
# 2 TS=(anemi* OR anaemi*)
# 3 TS=(random* OR rct* OR crossover OR masked OR blind* OR placebo* OR meta‐analysis OR systematic review* OR meta‐analys*)
# 4 #3 AND #2 AND #1

CINAHL Plus (EBSCO)

S1 (MH "Clinical Trials+")
S2 PT Clinical trial
S3 TX clinic* n1 trial* or TX ( (trebl* n1 blind*) or (trebl* n1 mask*) ) or TX ( (tripl* n1 blind*) or (tripl* n1 mask*) )
S4 TX ( (singl* n1 blind*) or (singl* n1 mask*) ) or TX ( (doubl* n1 blind*) or (doubl* n1 mask*) )
S5 TX randomi* control* trial*
S6 (MH "Random Assignment")
S7 TX random* allocat*
S8 TX placebo*
S9 (MH "Placebos")
S10 (MH "Quantitative Studies")
S11 TX allocat* random*
S12 S1 or S2 or S3 or S4 or S5 or S6 or S7 or S8 or S9 or S10 or S11
S13 (MH "Iron")
S14 (iron OR ferrous OR ferric)
S15 S13 or S14
S16 (MH "Anemia+")
S17 (anemi* OR anaemi*)
S18 S16 or 17
S19 S15 and S18
S20 S12 and S20

Clinicaltrials.gov
Search terms: Randomized
Study type: Interventional Studies
Conditions: anemia OR anaemic
Interventions: iron OR ferrous OR ferric

Study flow diagram.
Figures and Tables -
Figure 1

Study flow diagram.

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies. Twenty‐one studies are included in this review.
Figures and Tables -
Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies. Twenty‐one studies are included in this review.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figures and Tables -
Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Comparison 1 Oral iron vs inactive control, Outcome 1 Mortality.
Figures and Tables -
Analysis 1.1

Comparison 1 Oral iron vs inactive control, Outcome 1 Mortality.

Comparison 1 Oral iron vs inactive control, Outcome 2 Proportion requiring blood transfusion.
Figures and Tables -
Analysis 1.2

Comparison 1 Oral iron vs inactive control, Outcome 2 Proportion requiring blood transfusion.

Comparison 1 Oral iron vs inactive control, Outcome 3 Length of hospital stay.
Figures and Tables -
Analysis 1.3

Comparison 1 Oral iron vs inactive control, Outcome 3 Length of hospital stay.

Comparison 1 Oral iron vs inactive control, Outcome 4 Haemoglobin.
Figures and Tables -
Analysis 1.4

Comparison 1 Oral iron vs inactive control, Outcome 4 Haemoglobin.

Comparison 1 Oral iron vs inactive control, Outcome 5 Quality of life.
Figures and Tables -
Analysis 1.5

Comparison 1 Oral iron vs inactive control, Outcome 5 Quality of life.

Comparison 1 Oral iron vs inactive control, Outcome 6 Serious adverse events.
Figures and Tables -
Analysis 1.6

Comparison 1 Oral iron vs inactive control, Outcome 6 Serious adverse events.

Comparison 2 Parenteral iron vs inactive control, Outcome 1 Mortality.
Figures and Tables -
Analysis 2.1

Comparison 2 Parenteral iron vs inactive control, Outcome 1 Mortality.

Comparison 2 Parenteral iron vs inactive control, Outcome 2 Proportion requiring blood transfusion.
Figures and Tables -
Analysis 2.2

Comparison 2 Parenteral iron vs inactive control, Outcome 2 Proportion requiring blood transfusion.

Comparison 2 Parenteral iron vs inactive control, Outcome 3 Haemoglobin.
Figures and Tables -
Analysis 2.3

Comparison 2 Parenteral iron vs inactive control, Outcome 3 Haemoglobin.

Comparison 2 Parenteral iron vs inactive control, Outcome 4 Quality of life.
Figures and Tables -
Analysis 2.4

Comparison 2 Parenteral iron vs inactive control, Outcome 4 Quality of life.

Comparison 2 Parenteral iron vs inactive control, Outcome 5 Serious adverse events.
Figures and Tables -
Analysis 2.5

Comparison 2 Parenteral iron vs inactive control, Outcome 5 Serious adverse events.

Comparison 3 Parenteral iron vs oral iron, Outcome 1 Mortality.
Figures and Tables -
Analysis 3.1

Comparison 3 Parenteral iron vs oral iron, Outcome 1 Mortality.

Comparison 3 Parenteral iron vs oral iron, Outcome 2 Proportion requiring blood transfusion.
Figures and Tables -
Analysis 3.2

Comparison 3 Parenteral iron vs oral iron, Outcome 2 Proportion requiring blood transfusion.

Comparison 3 Parenteral iron vs oral iron, Outcome 3 Mean blood transfused.
Figures and Tables -
Analysis 3.3

Comparison 3 Parenteral iron vs oral iron, Outcome 3 Mean blood transfused.

Comparison 3 Parenteral iron vs oral iron, Outcome 4 Haemoglobin.
Figures and Tables -
Analysis 3.4

Comparison 3 Parenteral iron vs oral iron, Outcome 4 Haemoglobin.

Comparison 3 Parenteral iron vs oral iron, Outcome 5 Quality of life.
Figures and Tables -
Analysis 3.5

Comparison 3 Parenteral iron vs oral iron, Outcome 5 Quality of life.

Comparison 3 Parenteral iron vs oral iron, Outcome 6 Serious adverse events.
Figures and Tables -
Analysis 3.6

Comparison 3 Parenteral iron vs oral iron, Outcome 6 Serious adverse events.

Comparison 4 Iron: different preparations, Outcome 1 Mortality.
Figures and Tables -
Analysis 4.1

Comparison 4 Iron: different preparations, Outcome 1 Mortality.

Comparison 4 Iron: different preparations, Outcome 2 Haemoglobin.
Figures and Tables -
Analysis 4.2

Comparison 4 Iron: different preparations, Outcome 2 Haemoglobin.

Comparison 4 Iron: different preparations, Outcome 3 Serious adverse events.
Figures and Tables -
Analysis 4.3

Comparison 4 Iron: different preparations, Outcome 3 Serious adverse events.

Comparison 5 Subgroup analysis, Outcome 1 Mortality (parenteral iron vs inactive control stratified by clinical setting).
Figures and Tables -
Analysis 5.1

Comparison 5 Subgroup analysis, Outcome 1 Mortality (parenteral iron vs inactive control stratified by clinical setting).

Comparison 5 Subgroup analysis, Outcome 2 Mortality (parenteral iron vs inactive control stratified by erythropoietin use).
Figures and Tables -
Analysis 5.2

Comparison 5 Subgroup analysis, Outcome 2 Mortality (parenteral iron vs inactive control stratified by erythropoietin use).

Comparison 5 Subgroup analysis, Outcome 3 Mortality (parenteral iron vs oral iron stratified by clinical setting).
Figures and Tables -
Analysis 5.3

Comparison 5 Subgroup analysis, Outcome 3 Mortality (parenteral iron vs oral iron stratified by clinical setting).

Summary of findings for the main comparison. Oral iron vs inactive control for anaemic patients

Oral iron vs inactive control for anaemic patients

Patient or population: patients with anaemia
Settings: variable
Intervention: oral iron vs inactive control

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

Number of participants
(studies)

Quality of the evidence
(GRADE)

Assumed risk

Corresponding risk

Inactive control

Oral iron

Mortality

100 per 1000

105 per 1000

(68 to 161)

RR 1.05

(0.68 to 1.61)

659
(4 studies)

⊕⊝⊝⊝
Very lowa,b,c,d

Proportion requiring blood transfusion

279 per 1000

206 per 1000
(153 to 276)

RR 0.74
(0.55 to 0.99)

546
(3 studies)

⊕⊝⊝⊝
Very lowa,d

Length of hospital stay

Mean hospital stay in control groups was
21.3 days

Mean hospital stay in intervention groups was
2.50 lower
(6.82 lower to 1.82 higher)

300
(1 study)

⊕⊝⊝⊝
Very lowa,d,e

Haemoglobin
g/dL

Mean haemoglobin in control groups ranged between 11.4 g/dL and 12.4 g/dL

Point estimate of haemoglobin in intervention groups in the individual studies was 0.30 to 3.10 higher

402
(4 studies)

⊕⊝⊝⊝
Very lowa,d,f

Quality of life

Mean quality of life in intervention groups was
0.13 standard deviations lower
(0.37 lower to 0.1 higher)

276
(1 study)

⊕⊝⊝⊝
Very lowa,d,g

Serious adverse events

205 per 1000

197 per 1000
(156 to 250)

RR 0.96

(0.76 to 1.22)

731
(5 studies)

⊕⊝⊝⊝
Very lowa,b,c,d

*The basis for the assumed risk is the average risk among controls. The corresponding risk (and its 95% confidence interval) is based on assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio.

GRADE Working Group grades of evidence.
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

aTrial(s) reporting this outcome was/were at high risk of bias.
bFewer than 300 events in either group.
cConfidence intervals overlapped 1 and either 0.75 or 1.25 or both.
dSeveral trials did not report this outcome.
eMean difference overlapped minimal clinically important difference.
fSignificant heterogeneity was noted by lack of overlap of confidence intervals and by I2. So, point estimates in the studies are presented.
gStandardised mean difference overlapped 0 and ‐0.25 or +0.25 or both.

Figures and Tables -
Summary of findings for the main comparison. Oral iron vs inactive control for anaemic patients
Summary of findings 2. Parenteral iron vs inactive control for anaemic patients

Parenteral iron vs inactive control for anaemic patients

Patient or population: patients with anaemia
Settings: variable
Intervention: parenteral iron vs inactive control

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

Number of participants
(studies)

Quality of the evidence
(GRADE)

Assumed risk

Corresponding risk

Inactive control

Parenteral iron

Mortality

46 per 1000

47 per 1000
(29 to 77)

RR 1.04

(0.63 to 1.69)

2141
(10 studies)

⊕⊝⊝⊝
Very lowa,b,c,d

Proportion requiring blood transfusion

182 per 1000

153 per 1000
(120 to 193)

RR 0.84

(0.66 to 1.06)

1315
(8 studies)

⊕⊝⊝⊝
Very lowa,b,c

Haemoglobin
g/dL

Mean haemoglobin in control groups ranged between 11.2 g/dL and 13.0 g/dL

The point estimate of haemoglobin in intervention groups in the individual studies was from 0.30 to 3.00 higher

1371
(9 studies)

⊕⊝⊝⊝
Very lowa,e

Quality of life

The point estimate of haemoglobin in intervention groups in the individual studies was between

0.04 standard deviations lower and 0.44 standard deviations higher

1629
(4 studies)

⊕⊝⊝⊝
Very lowa,d,e,f,g

Serious adverse events

184 per 1000

184 per 1000

RR 1

(0.74 to 1.34)

1802
(7 studies)

⊕⊝⊝⊝
Very lowa,b,c,d,g

*The basis for the assumed risk is the average risk among controls. The corresponding risk (and its 95% confidence interval) is based on assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio.

GRADE Working Group grades of evidence.
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

aTrial(s) reporting this outcome was/were at high risk of bias.
bFewer than 300 events in either group.
cConfidence intervals overlapped 1 and either 0.75 or 1.25 or both.
dPublication bias could not be explored because fewer than 10 trials were included.
eHeterogeneity was significant, as was noted by lack of overlap of confidence intervals and by I2. So, point estimates in the studies are presented.
fStandardised mean difference overlapped 0 and ‐0.25 or +0.25 or both.
gSeveral trials did not report this outcome.

Figures and Tables -
Summary of findings 2. Parenteral iron vs inactive control for anaemic patients
Summary of findings 3. Parenteral iron vs oral iron for anaemic patients

Parenteral iron vs oral iron for anaemic patients

Patient or population: patients with anaemia
Settings: variable
Intervention: parenteral iron vs oral iron

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

Number of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Oral iron

Parenteral iron

Mortality

12 per 1000

18 per 1000
(7 to 47)

RR 1.49

(0.56 to 3.94)

1009
(6 studies)

⊕⊝⊝⊝
Very lowa,b,c,d

Proportion requiring blood transfusion

189 per 1000

115 per 1000
(45 to 299)

RR 0.61

(0.24 to 1.58)

371
(2 studies)

⊕⊝⊝⊝
Very lowa,b,c,d,e

Mean blood transfused
units

Mean mean blood transfused in control groups was
0.86 unit

Mean blood transfused in intervention groups was
0.54 lower
(0.96 to 0.12 lower)

44
(1 study)

⊕⊝⊝⊝
Very lowa,d

Haemoglobin
g/dL

Mean haemoglobin in control groups was between
9.5 g/dL and 12.5 g/dL

Mean haemoglobin in intervention groups was
0.5 lower
(0.73 to 0.27 lower)

769
(6 studies)

⊕⊕⊝⊝
Lowa,d

Quality of life

Mean quality of life in intervention groups was
0.02 standard deviations lower
(0.16 lower to 0.13 higher)

771
(3 studies)

⊕⊝⊝⊝
Very lowa,d,f

SMD 0.09 (‐0.04 to 0.22)

Serious adverse events

131 per 1000

162 per 1000
(130 to 202)

RR 1.23

(0.99 to 1.54)

1100
(7 studies)

⊕⊝⊝⊝
Very lowa,b,c

*The basis for the assumed risk is average risk among controls. The corresponding risk (and its 95% confidence interval) is based on assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio.

GRADE Working Group grades of evidence.
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

aTrial(s) reporting this outcome was/were at high risk of bias.
bFewer than 300 events in either group.
cConfidence intervals overlapped 1 and either 0.75 or 1.25 or both.
dPublication bias could not be explored because fewer than 10 trials were included.
eHeterogeneity was significant, as was noted by lack of overlap of confidence intervals and by I2.
fStandardised mean difference overlapped 0 and ‐0.25 or +0.25 or both.

Figures and Tables -
Summary of findings 3. Parenteral iron vs oral iron for anaemic patients
Table 1. World Health Organization (WHO) definition of anaemia

Group characteristics        

Haemoglobin
(g/L) 

Haematocrit
(mmol/L)*

Haematocrit
(litres/L)a

Children (6 months to 59 months)   

110

6.83

0.33

Children (5 to 11 years)

115 

7.13

0.34

Children (12 to 14 years)  

120

7.45

0.36

Non‐pregnant women (over 15 years of age)  

120 

7.45

0.36

Pregnant women   

110

6.83

0.33

Men (over 15 years of age)   

130

8.07

0.39

aHaematocrit is the volume of packed red blood cells expressed in terms of fraction or percentages in a whole blood specimen (NCBI‐Hematocrit).

Figures and Tables -
Table 1. World Health Organization (WHO) definition of anaemia
Table 2. Details of participants and interventions

 

Study name

Participant characteristics

Clinical setting

Co‐interventions

Routes and methods of administration of parenteral iron

 

Comparison

Sample size (after postrandomisation dropouts)

Mean age (years)

Females

Postrandomisation dropouts

Blood loss conditions

Cancer

Preoperative

Chronic heart failure

Autoimmune

Miscellaneous

Added erythropoietin

Added oral iron

Parenteral iron—intravenous

Parenteral iron—intramuscular

Total dose infusion

Abrahamsen 1965

30

Not stated

Not stated

0 (0%)

Yes

No

No

No

No

No

No

Not applicable

No

Yes

No

Parenteral iron vs oral iron vs inactive control

Anker 2009

158

Not stated

Not stated

0 (0%)

No

No

No

Yes

No

No

No

No

Yes

No

No

Parenteral iron vs inactive control

Auerbach 2010

238

63

158 (66.4%)

5 (2.1%)

No

Yes

No

No

No

No

Yes

Oral iron was allowed as part of standard treatment

Yes

No

No

Parenteral iron vs inactive control

Bastit 2008

396

61

240 (60.6%)

2 (0.5%)

No

Yes

No

No

No

No

Yes

Oral iron was allowed as part of standard treatment

Yes

No

No

Parenteral iron vs inactive control

Beck‐da‐Silva 2013

23

66

7

Not stated

No

No

No

Yes

No

No

No

Not applicable

Yes

No

No

Parenteral iron vs oral iron vs inactive control

Dangsuwan 2010

44

51

44 (100%)

0 (0%)

No

Yes

No

No

No

No

No

Not applicable

Yes

No

No

Parenteral iron vs oral iron

Edwards 2009

18

Not stated

Not stated

Not stated

No

No

Yes

No

No

No

No

No

Yes

No

No

Parenteral iron vs inactive control

Evstatiev 2011

483

39

284 (58.8%)

2 (0.4%)

No

No

No

No

Yes

No

No

No

Yes

No

Yes

Different preparations

Hedenus 2007

67

76

42 (62.7%)

0 (0%)

No

Yes

No

No

No

No

Yes

No

Yes

No

No

Parenteral iron vs inactive control

Hetzel 2012

605

Not stated

Not stated

Not stated

No

No

No

No

No

Yes

No

No

Yes

No

No

Different preparations

Karkouti 2006

21

62

5 (23.8%)

5 (19.2%)

Yes

No

No

No

No

No

No

Yes

Yes

No

No

Parenteral iron vs inactive control

Lidder 2007

20

Not stated

9 (45%)

Not stated

No

No

Yes

No

No

No

No

Not applicable

Not applicable

Not applicable

Not applicable

Oral iron vs inactive control

Lindgren 2009

91

42

63 (69.2%)

Not stated

No

No

No

No

Yes

No

No

Not applicable

Yes

No

No

Parenteral iron vs oral iron

Maccio 2010

148

68

59 (39.9%)

0 (0%)

No

Yes

No

No

No

No

Yes

Not applicable

Yes

No

No

Parenteral iron vs oral iron

Madi‐Jebara 2004

80

Not stated

Not stated

0 (0%)

No

No

Yes

No

No

No

No

No

Yes

No

No

Parenteral iron vs inactive control

Parker 2010

300

82

245 (81.7%)

0 (0%)

Yes

No

No

No

No

No

No

Not applicable

Not applicable

Not applicable

Not applicable

Oral iron vs inactive control

Pieracci 2009

200

57

103 (51.5%)

0 (0%)

No

No

No

No

No

Yes

No

Not applicable

Not applicable

Not applicable

Not applicable

Oral iron vs inactive control

Steensma 2010

490

64

320 (65.3%)

12 (2.4%)

No

Yes

No

No

No

No

Yes

Not applicable

Yes

No

No

Parenteral iron vs oral iron vs inactive control

Sutton 2004

72

70

30 (41.7%)

Not stated

Yes

No

No

No

No

No

No

Not applicable

Not applicable

Not applicable

Not applicable

Oral iron vs inactive control

Vadhan‐Raj 2013

808

45

720

4 (0.5%)

No

No

No

No

No

Yes

No

No

Yes

No

No

Parenteral iron vs inactive control

Van Wyck 2009

453

39

453 (100%)

24 (5%)

Yes

No

No

No

No

No

No

Not applicable

Yes

No

No

Parenteral iron vs oral iron

Figures and Tables -
Table 2. Details of participants and interventions
Comparison 1. Oral iron vs inactive control

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mortality Show forest plot

4

659

Risk Ratio (M‐H, Random, 95% CI)

1.05 [0.68, 1.61]

2 Proportion requiring blood transfusion Show forest plot

3

546

Risk Ratio (M‐H, Random, 95% CI)

0.74 [0.55, 0.99]

3 Length of hospital stay Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

4 Haemoglobin Show forest plot

4

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

4.1 Final haemoglobin

3

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

4.2 Change in haemoglobin

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

5 Quality of life Show forest plot

1

Std. Mean Difference (IV, Random, 95% CI)

Totals not selected

6 Serious adverse events Show forest plot

5

731

Risk Ratio (M‐H, Fixed, 95% CI)

0.96 [0.76, 1.22]

Figures and Tables -
Comparison 1. Oral iron vs inactive control
Comparison 2. Parenteral iron vs inactive control

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mortality Show forest plot

10

2141

Risk Ratio (M‐H, Random, 95% CI)

1.04 [0.63, 1.69]

2 Proportion requiring blood transfusion Show forest plot

8

1315

Risk Ratio (M‐H, Random, 95% CI)

0.84 [0.66, 1.06]

3 Haemoglobin Show forest plot

9

Mean Difference (IV, Random, 95% CI)

Totals not selected

3.1 Final haemoglobin

6

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

3.2 Change in haemoglobin

3

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

4 Quality of life Show forest plot

4

Std. Mean Difference (IV, Random, 95% CI)

Totals not selected

5 Serious adverse events Show forest plot

7

1802

Risk Ratio (M‐H, Random, 95% CI)

1.00 [0.74, 1.34]

Figures and Tables -
Comparison 2. Parenteral iron vs inactive control
Comparison 3. Parenteral iron vs oral iron

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mortality Show forest plot

6

1009

Risk Ratio (M‐H, Random, 95% CI)

1.49 [0.56, 3.94]

2 Proportion requiring blood transfusion Show forest plot

2

371

Risk Ratio (M‐H, Random, 95% CI)

0.61 [0.24, 1.58]

3 Mean blood transfused Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

4 Haemoglobin Show forest plot

6

769

Mean Difference (IV, Random, 95% CI)

‐0.50 [‐0.73, ‐0.27]

4.1 Final haemoglobin

3

148

Mean Difference (IV, Random, 95% CI)

‐0.47 [‐0.74, ‐0.21]

4.2 Change in haemoglobin

3

621

Mean Difference (IV, Random, 95% CI)

‐0.41 [‐1.29, 0.46]

5 Quality of life Show forest plot

3

771

Std. Mean Difference (IV, Random, 95% CI)

‐0.02 [‐0.16, 0.13]

6 Serious adverse events Show forest plot

7

1100

Risk Ratio (M‐H, Random, 95% CI)

1.23 [0.99, 1.54]

Figures and Tables -
Comparison 3. Parenteral iron vs oral iron
Comparison 4. Iron: different preparations

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mortality Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

1.1 Intravenous iron: ferrumoxytol vs iron sucrose

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2 Haemoglobin Show forest plot

2

Mean Difference (IV, Random, 95% CI)

Totals not selected

2.1 Intravenous iron: ferric carboxymaltose vs iron sucrose

1

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

2.2 Intravenous iron: ferrumoxytol vs iron sucrose

1

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

3 Serious adverse events Show forest plot

2

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

3.1 Intravenous iron: ferric carboxymaltose vs iron sucrose

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

3.2 Intravenous iron: ferrumoxytol vs iron sucrose

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 4. Iron: different preparations
Comparison 5. Subgroup analysis

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mortality (parenteral iron vs inactive control stratified by clinical setting) Show forest plot

10

2141

Risk Ratio (M‐H, Random, 95% CI)

1.04 [0.63, 1.69]

1.1 Blood loss

2

41

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

1.2 Cancer

4

1028

Risk Ratio (M‐H, Random, 95% CI)

1.03 [0.48, 2.25]

1.3 Preoperative anaemic patients

1

80

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

1.4 Chronic heart failure

2

184

Risk Ratio (M‐H, Random, 95% CI)

0.87 [0.16, 4.82]

1.5 Other settings

1

808

Risk Ratio (M‐H, Random, 95% CI)

0.66 [0.06, 7.22]

2 Mortality (parenteral iron vs inactive control stratified by erythropoietin use) Show forest plot

10

2141

Risk Ratio (M‐H, Random, 95% CI)

1.04 [0.63, 1.69]

2.1 Supplementary erythropoietin

3

701

Risk Ratio (M‐H, Random, 95% CI)

0.81 [0.34, 1.91]

2.2 No supplementary erythropoietin

7

1440

Risk Ratio (M‐H, Random, 95% CI)

1.50 [0.58, 3.90]

3 Mortality (parenteral iron vs oral iron stratified by clinical setting) Show forest plot

5

861

Risk Ratio (M‐H, Random, 95% CI)

1.49 [0.56, 3.94]

3.1 Blood loss

2

473

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

3.2 Cancer

2

371

Risk Ratio (M‐H, Random, 95% CI)

1.33 [0.47, 3.73]

3.3 Chronic heart failure

1

17

Risk Ratio (M‐H, Random, 95% CI)

3.64 [0.20, 65.86]

Figures and Tables -
Comparison 5. Subgroup analysis