***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective To explore the safety and efficacy of intravenous ( IV ) iron sucrose in maintenance peritoneal dialysis ( PD ) . Design R and omized , controlled , parallel-group single-center trial . Setting Blood Purification Center of Chaoyang , Beijing Capital University of Medical Science , China . Methods 46 patients on PD were involved in this trial . 26 patients received IV iron sucrose ( 200 mg iron ) once per week for 4 weeks then once every other week for a further 4 weeks . The other 20 patients received oral ferrous succinate , 200 mg three times per day , for 8 weeks . Hemoglobin , hematocrit , serum ferritin ( SF ) level , and transferrin saturation ( TSAT ) were assessed at baseline and then again after 2 , 4 , and 8 weeks of treatment . Results There were no differences between the IV and oral groups in terms of sex , age , duration of PD , mean dialysate dosage per day , erythropoietin dosage per week , or hematological parameters at baseline . After 4 and 8 weeks of treatment , mean Hb and Hct were significantly increased in the IV group and were also significantly higher than those in the oral group . Levels of SF and TSAT were also significantly increased in the IV group , and significantly higher than in the oral group . After 8 weeks , the response rate in the IV group was 94.8 % , which was significantly higher than that in the oral group . The mean erythropoietin dose was significantly lower in the IV group than in the oral group . Hb , Hct , SF , and TSAT levels were maintained between 4 and 8 weeks in the IV group despite the decrease in dose frequency . There were no adverse events with IV iron . Eight patients in the oral group had adverse gastrointestinal effects . Conclusion IV iron sucrose is safe in PD patients . It increases Hb levels and serum iron parameters more effectively than oral iron ; it is well tolerated and can permit reductions in the required dose of erythropoietin BACKGROUND Ferumoxytol is a unique intravenous ( i.v . ) iron therapy . This report examines factors affecting hemoglobin response to i.v . ferumoxytol , and the relationship between hematologic parameters , concomitant erythropoiesis-stimulating agents ( ESA ) , and adverse events ( AEs ) in nondialysis CKD patients . METHODS A series of post-hoc efficacy and safety analyses were performed using pooled data from two identically design ed Phase III studies in 608 nondialysis CKD patients r and omized to receive two 510 mg i.v . injections of ferumoxytol within 5 ± 3 days versus oral iron . RESULTS Ferumoxytol result ed in a significant increase in hemoglobin in the presence and absence of ESA , and across a range of baseline hemoglobin , transferrin saturation , ferritin , and reticulocyte hemoglobin content levels . Adverse event rates  with ferumoxytol were similar across quartiles of change in hemoglobin ; there were no trends suggesting an increased rate of cardiovascular AEs with higher maximum achieved hemoglobin or faster rate of hemoglobin rise . There was no meaningful difference in the rate of AEs , serious AEs , and cardiovascular AEs between patients receiving or not receiving ESA . CONCLUSIONS These analyses add to the knowledge of predictors of response and safety outcomes associated with i.v . iron therapy in nondialysis CKD patients BACKGROUND Preliminary clinical evidence suggests that heme iron polypeptide ( HIP ) might represent a promising , novel oral iron supplementation strategy in chronic kidney disease . The aim of this multi-centre r and omized controlled trial was to determine the ability of HIP administration to augment iron stores in darbepoetin (DPO)-treated patients compared with conventional oral iron supplementation . METHODS Adult peritoneal dialysis ( PD ) patients treated with DPO were r and omized 1:1 to receive two capsules daily of either HIP or ferrous sulphate per os for 6 months . The primary outcome measure was transferrin saturation ( TSAT ) . Secondary outcomes comprised serum ferritin , haemoglobin , DPO dose and responsiveness , and adverse events . RESULTS Sixty-two patients were r and omized to HIP ( n = 32 ) or ferrous sulphate ( n = 30 ) . On intention-to-treat analysis , the median ( inter-quartile range ) TSAT was 22 % ( 16 - 29 ) in the HIP group compared with 20 % ( 17 - 26 ) in controls ( P = 0.65 ) . HIP treatment was not significantly associated with TSAT at 6 months on multivariable analysis ( P = 0.95 ) . Similar results were found on per- protocol analysis and subgroup analysis in iron-deficient patients . Serum ferritin levels at 6 months were significantly lower in the HIP group ( P = 0.003 ) , while the cost of HIP was 7-fold higher than that of ferrous sulphate . No other differences in secondary outcomes were observed . CONCLUSIONS HIP showed no clear safety or efficacy benefit in PD patients compared with conventional oral iron supplements . The reduction in serum ferritin levels and high costs associated with HIP therapy suggest that this agent is unlikely to have a significant role in iron supplementation in PD patients Background Rigorous data are sparse concerning the optimal route of administration and dosing strategy for iron therapy with or without concomitant erythropoiesis-stimulating agent ( ESA ) therapy for the management of iron deficiency anaemia in patients with non-dialysis dependent chronic kidney disease ( ND-CKD ) . Methods FIND-CKD was a 56-week , open-label , multicentre , prospect i ve , r and omized three-arm study ( NCT00994318 ) of 626 patients with ND-CKD and iron deficiency anaemia r and omized to ( i ) intravenous ( IV ) ferric carboxymaltose ( FCM ) at an initial dose of 1000 mg iron with subsequent dosing as necessary to target a serum ferritin level of 400–600 µg/L ( ii ) IV FCM at an initial dose of 200 mg with subsequent dosing as necessary to target serum ferritin 100–200 µg/L or ( iii ) oral ferrous sulphate 200 mg iron/day . The primary end point was time to initiation of other anaemia management ( ESA therapy , iron therapy other than study drug or blood transfusion ) or a haemoglobin ( Hb ) trigger ( two consecutive Hb values < 10 g/dL without an increase of ≥0.5 g/dL ) . Results The background , rationale and study design of the trial are presented here . The study has been completed and results are expected in late 2013 . Discussion FIND-CKD was the longest r and omized trial of IV iron therapy to date . Its findings will address several unanswered questions regarding iron therapy to treat iron deficiency anaemia in patients with ND-CKD . It was also the first r and omized trial to utilize both a high and low serum ferritin target range to adjust IV iron dosing , and the first not to employ Hb response as its primary end point BACKGROUND The Dialysis Outcomes and Practice Patterns Study ( DOPPS ) is a prospect i ve , observational study based on data collected from nationally representative sample s of haemodialysis facilities . The burden of anaemia in haemodialysis patients is substantial , leading to considerable morbidity , mortality and reduced quality of life . This study examines anaemia management and outcomes based on data from five European countries participating in the DOPPS : France , Germany , Italy , Spain and the UK . METHODS Baseline data on demographics , co-morbidities and anaemia management in 4591 haemodialysis patients from 101 nephrology facilities were collected in 1998 - 2000 . Using multivariate Cox survival analyses to adjust for patient characteristics , relationships between haemoglobin concentration at study entry and rates of mortality and hospitalization were evaluated . RESULTS For a year 2000 sample of prevalent patients on haemodialysis > 180 days , mean haemoglobin concentration was 11.0 g/dl ; 53 % had a haemoglobin concentration > or = 11 g/dl [ 1998 - 1999 = 44 % ( P < 0.05 ) ] . In 2000 , 84 % of prevalent patients were prescribed recombinant human erythropoietin ( rHuEpo ) . Higher haemoglobin concentrations were associated with decreased relative risk ( RR ) for mortality ( RR = 0.95 for every 1 g/dl higher haemoglobin , P = 0.03 ) and hospitalization ( RR = 0.96 , P = 0.02 ) . Patients with haemoglobin < 10 g/dl were 29 % more likely to be hospitalized than patients with haemoglobin 11 - 12 g/dl ( P < 0.001 ) . CONCLUSION Even after adjustment , lower haemoglobin concentrations were associated with higher morbidity and mortality in European haemodialysis patients . A trend to increased haemoglobin concentrations was observed following publication of the European Best Practice Guidelines ( EBPG ) on anaemia management for chronic kidney disease patients , but efforts must continue to achieve EBPG goals Background . Iron deficiency is a common cause of anaemia and hyporesponsiveness to erythropoiesis-stimulating agents ( ESAs ) in non-dialysis-dependent chronic kidney disease ( ND-CKD ) patients .  Current intravenous iron agents can not be administered in a single high dose because of adverse effects . Ferric carboxymaltose , a non-dextran parenteral iron preparation , can be rapidly administered in high doses . Methods . This open-label trial r and omized 255 subjects with glomerular filtration rates ≤ 45 mL/min/1.73 m2 , haemoglobin ≤ 11 g/dL , transferrin saturation ≤ 25 % , ferritin ≤ 300 ng/mL , and stable ESA dose to either intravenous ferric carboxymaltose 1000 mg over 15 min ( with up to two additional doses of 500 mg at 2-week intervals ) or oral ferrous sulphate 325 mg thrice daily for a total of 195 mg elemental iron daily for 56 days . Results . In the modified intent-to-treat population , the proportion of subjects achieving a haemoglobin increase ≥ 1 g/dL at any time was 60.4 % with ferric carboxymaltose and 34.7 % with oral iron ( P < 0.001 ) . At Day 42 , mean increase in haemoglobin was 0.95 ± 1.12 vs 0.50 ± 1.23 g/dL ( P = 0.005 ) , mean increase in ferritin was 432 ± 189 ng/mL vs 18 ± 45 ng/mL ( P < 0.001 ) and mean increase in transferrin saturation was 13.6 ± 11.9 % vs 6.1 ± 8.1 % ( P < 0.001 ) . Treatment-related adverse events were significantly fewer with ferric carboxymaltose than with oral iron ( 2.7 % and 26.2 % , respectively ; P < 0.0001 ) . Conclusions . We conclude that 1000 mg ferric carboxymaltose can be rapidly administered , is more effective and is better tolerated than oral iron for treatment of iron deficiency in ND-CKD patients BACKGROUND In patients with chronic kidney disease ( CKD ) , anemia is associated with left ventricular hypertrophy and adverse cardiovascular and clinical outcomes . Moreover , anemia is associated with a reduction in quality of life , particularly when the hemoglobin level drops below 100 g/l . 1 Thus , the goal of treating anemia in iron-replete patients with erythropoietic-stimulating agents ( ESAs ) is to reduce the likelihood of cardiovascular events , improve patients ’ survival , and improve patients ’ quality of life while minimizing any deleterious effects of the drug . Given that ESAs increase blood pressure and have other potential side effects , it is also important to assess whether the quantity of the ESA used might contribute to adverse events such as more rapid deterioration of kidney function , earlier requirement for dialysis , and vascular access failure . It is acknowledged that , if left untreated , patients with severe anemia may require blood transfusions , which have associated risks and costs , and possible implication s for patients awaiting a kidney transplant . In light of this , in most developed countries , the question for CKD patients with significant anemia has often not been whether to use ESAs , but when to use them and what target hemoglobin level to aim for . 2 The earliest anemia correction studies in nondialysischronic kidney disease ( ND-CKD ) and hemodialysis-chronic kidney disease ( HD-CKD ) patients compared the use of erythropoietin a with placebo . 3–5 Most early studies were not design ed and powered to examine clinical outcomes other than quality of life , and no differences were apparent in such other outcomes . Several of the studies showed improvements in quality of life compared with placebo . 3–5 Subsequent r and omized control trials ( RCTs ) have tended to examine the impact of using ESAs to achieve different target hemoglobin level ranges 
    Output:
    
Gastrointestinal side effects were more common with oral iron , but hypotensive and allergic reactions were more common with IV iron .
AUTHORS ' CONCLUSIONS The included studies provide strong evidence for increased ferritin and transferrin saturation levels , together with a small increase in haemoglobin , in patients with CKD who were treated with IV iron compared with oral iron .
From a limited body of evidence , we identified a significant reduction in ESA requirements in patients treated with IV iron , and found no significant difference in mortality .
We therefore suggest that further studies that focus on patient-centred outcomes are needed to determine if the use of IV iron is justified on the basis of reductions in ESA dose and cost , improvements in patient quality of life , and with few serious adverse effects