Anaemia is a common clinical
finding among patients with chronic kidney disease (CKD) and
is associated with significant morbidity and healthcare costs.
Iron deficiency is an important contributing factor, and adequate
iron supplementation is essential to optimize the management
of anaemia of CKD. Oral iron is convenient and inexpensive but
is poorly absorbed and associated with gastrointestinal distress.
Intravenous iron overcomes these limitations but is more
expensive, requires additional clinical visits for administration
and is associated with serious adverse events. Oral heme iron
polypeptide (HIP) is a newer dosage form that has been reported
to have higher bioavailability and fewer side effects when
compared with non-heme iron in healthy subjects, but data in
patients with CKD are limited. The purpose of this review is to
evaluate the safety and effectiveness of HIP for the management
of CKD.
Methods:Searches for PubMed (1947–2015) and International
Pharmaceutical Abstracts (1970–2015) were conducted using the
following terms: heme iron, heme iron polypeptide, oral iron,
anaemia and chronic kidney disease. The bibliography of each
relevant article was evaluated for additional studies. Articles
were selected for review if they were published in the English
language and were randomized controlled trials evaluating the
bioavailability, tolerability or efficacy of oral HIP in human
subjects with CKD.
Results and Discussion:This search yielded three clinical
studies. The safety and efficacy of HIP was evaluated in a
total of 161 subjects with anaemia and various stages of CKD.
HIP was consistently associated with lower ferritin values
when compared with traditional iron supplementation. With
few exceptions, the effect of HIP on haemoglobin, haematocrit,
transferrin saturation and recombinant human erythropoietin
dose, and adverse effects appeared similar to intravenous and
oral non-heme iron supplementation. The cost of HIP is
substantially more than non-heme iron and comparable to
intravenous iron.
What is New and Conclusion:Heme iron polypeptide does not
appear to confer benefit over traditional iron supplementation
among patients with anaemia of CKD and is more expensive