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Safety and Efficacy of Iron Chelators in Patients With Chronic Kidney Disease: A Systematic Review and Meta-Analysis

Humam Emad Rajha1, Richard Shamoon2, Ameer Almeshagbeh3

  • 1College of Medicine, QU Health, Qatar University, Doha, Qatar.

Hemodialysis International. International Symposium on Home Hemodialysis
|June 18, 2026
PubMed

Insights

Iron chelators reduce iron overload in chronic kidney disease (CKD) patients, improving anemia. However, limited evidence necessitates further high-quality trials to confirm efficacy and safety in CKD management.

Area of Science:

  • Nephrology
  • Hematology
  • Pharmacology

Background:

  • Iron overload in chronic kidney disease (CKD) exacerbates oxidative injury.
  • The therapeutic role of iron chelators in CKD is not well-established.

Purpose of the Study:

  • To assess the efficacy and safety of iron chelators in adult patients with CKD.
  • To synthesize current evidence on iron chelation in CKD.

Main Methods:

  • Systematic review and meta-analysis adhering to PRISMA 2020 guidelines.
  • Inclusion of randomized controlled trials and observational studies.
  • Analysis of iron indices, hematological parameters, and adverse events.

Main Results:

  • Eleven studies (206 patients) showed iron chelation reduced serum ferritin, transferrin, and serum iron.
  • Hemoglobin levels increased, while glucose levels decreased; lipid profiles remained unchanged.
  • Common gastrointestinal adverse events were noted, with rare serious events; high heterogeneity and potential bias were identified.

Conclusions:

  • Iron chelation effectively lowers iron stores and may benefit anemia in CKD.
  • Current evidence is limited by small sample sizes and study heterogeneity.
  • High-quality randomized controlled trials are required to determine the clinical utility and safety of iron chelators in CKD.
Abstract

Keywords:
chronic kidney diseasedeferasiroxdeferoxamineiron chelationiron overloadmeta‐analysissystematic review

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