Intravenous iron therapy did not significantly reduce all-cause mortality (RR 0.94) in patients with heart failure and chronic kidney disease, despite reducing heart failure hospitalizations.
Meta-Analysis (n=7,009)
Does intravenous iron therapy reduce mortality and cardiovascular events in patients with heart failure and chronic kidney disease?
Intravenous iron therapy significantly reduces the risk of heart failure hospitalization or cardiovascular death in patients with concurrent heart failure and chronic kidney disease, though it does not significantly reduce all-cause mortality.
Effect estimate: RR 0.94 (95% CI 0.81-1.10)
Absolute Event Rate: 25.2% vs 28.7%
p-value: p=0.46
Iron deficiency is highly prevalent in patients with heart failure (HF) complicated by chronic kidney disease (CKD), yet the efficacy of intravenous (IV) iron therapy remains unclear. We performed a meta-analysis of randomized controlled trials (RCTs) retrieved from Embase, PubMed, and the Cochrane Library from inception to January 1, 2026. A total of 8 RCTs involving 7009 participants were included. Clinical outcomes were assessed by generating forest plots using the random-effects model and pooling relative risks (RRs) or mean differences (MDs). IV iron therapy showed a significantly reduced incidence of first heart failure hospitalization or cardiovascular death (RR = 0.79, 95% CI: 0.72–0.86, P < 0.001), heart failure hospitalization or cardiovascular death (RR = 0.85, 95% CI: 0.75–0.98, P = 0.02) in HF-CKD patients as compared with the control group, with significant improvements in relevant biomarkers. Subgroup analyses revealed no effect modification by CKD status. Anemia status modified the treatment effect on all-cause mortality (P = 0.04). Anemic patients exhibited a trend toward clinical benefit (RR = 0.84, 95% CI: 0.70–1.01, P = 0.06), while no such trend was observed in non-anemic patients (RR = 1.28, 95% CI: 0.90–1.81, P = 0.16). Further large-sample, long-term trials are needed to identify the optimal patient population and clarify the long-term safety of this therapy.
Du et al. (2026) conducted a meta-analysis in Heart failure complicated by chronic kidney disease (n=7,009). Intravenous iron therapy vs. Placebo / Control was evaluated on All-cause mortality (RR 0.94, 95% CI 0.81-1.10, p=0.46). Intravenous iron therapy did not significantly reduce all-cause mortality (RR 0.94) in patients with heart failure and chronic kidney disease, despite reducing heart failure hospitalizations.