human
***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: 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 After total hip and knee replacement arthroplasty , patients may become anaemic and may be prescribed oral iron . There is , however , no published evidence that this is of benefit when used postoperatively . We treated 72 patients who were anaemic after primary total hip and knee arthroplasty by r and omly allocating them to receive six weeks of either oral ferrous sulphate ( 35 patients ) or a placebo ( 37 patients ) . Both groups of patients were similar in all aspects except for the treatment given . There was no statistically significant difference in the change of haemoglobin levels between the two groups . We therefore believe that the prescription of iron to all anaemic patients post-operatively should be avoided . The level of serum ferritin should be monitored at preoperative assessment Background Anaemia is a known risk factor for cardiovascular disease and treating anaemia in chronic kidney disease ( CKD ) may improve outcomes . However , little is known about the scope to improve primary care management of anaemia in CKD . Methods An observational study ( N = 1,099,292 ) with a nationally representative sample using anonymised routine primary care data from 127 Quality Improvement in CKD trial practice s ( IS RCT N5631023731 ) . We explored variables associated with anaemia in CKD : eGFR , haemoglobin ( Hb ) , mean corpuscular volume ( MCV ) , iron status , cardiovascular comorbidities , and use of therapy which associated with gastrointestinal bleeding , oral iron and deprivation score . We developed a linear regression model to identify variables amenable to improved primary care management . Results The prevalence of Stage 3–5 CKD was 6.76 % . Hb was lower in CKD ( 13.2 g/dl ) than without ( 13.7 g/dl ) . 22.2 % of people with CKD had World Health Organization defined anaemia ; 8.6 % had Hb ≤ 11 g/dl ; 3 % Hb ≤ 10 g/dl ; and 1 % Hb ≤ 9 g/dl . Normocytic anaemia was present in 80.5 % with Hb ≤ 11 ; 72.7 % with Hb ≤ 10 g/dl ; and 67.6 % with Hb ≤ 9 g/dl ; microcytic anaemia in 13.4 % with Hb ≤ 11 g/dl ; 20.8 % with Hb ≤ 10 g/dl ; and 24.9 % where Hb ≤ 9 g/dl . 82.7 % of people with microcytic and 58.8 % with normocytic anaemia ( Hb ≤ 11 g/dl ) had a low ferritin ( < 100ug/mL ) . Hypertension ( 67.2 % vs. 54 % ) and diabetes ( 30.7 % vs. 15.4 % ) were more prevalent in CKD and anaemia ; 61 % had been prescribed aspirin ; 73 % non-steroidal anti-inflammatory drugs ( NSAIDs ) ; 14.1 % warfarin 12.4 % clopidogrel ; and 53.1 % aspirin and NSAID . 56.3 % of people with CKD and anaemia had been prescribed oral iron . The main limitations of the study are that routine data are inevitably incomplete and definitions of anaemia have not been st and ardised . Conclusions Medication review is needed in people with CKD and anaemia prior to considering erythropoietin or parenteral iron . Iron stores may be depleted in over > 60 % of people with normocytic anaemia . Prescribing oral iron has not corrected anaemia Background Anemia secondary to iron deficiency is common in patients with non-dialysis dependent chronic kidney disease ( ND-CKD ) but it is unclear if oral supplementation is as effective as intravenous ( IV ) supplementation in re-establishing iron stores . The purpose of this study was to determine if oral Heme Iron Polypeptide ( HIP ) is as effective as IV iron sucrose in the treatment of iron-deficiency anemia for patients with ND-CKD . Methods Forty ND-CKD patients were r and omized ; 18 to HIP  11 mg orally 3 times per day and 22 to IV iron sucrose 200 mg monthly for 6 months . Baseline clinical and laboratory data were collected for all patients . The primary and secondary outcomes for the study were hemoglobin ( Hgb ) concentration and iron indices [ ferritin and percentage transferrin saturation ( TSAT ) ] at the end of 6 months respectively . Adverse events were also compared . Results The baseline demographic characteristics and laboratory values were similar for the two groups . After 6 months of treatment , Hb in the  HIP  group was 117 g/L and 113 g/L in the IV sucrose group ( p = 0.37 ) . The TSAT at 6 months was not different between the two groups { p = 0.82}but the serum ferritin was significantly higher in the IV iron sucrose group { 85.5 ug/L in HIP and 244 ug/L ; p = 0.004}. Overall adverse events were not different between the groups . Conclusion HIP is similar in efficacy to IV iron sucrose in maintaining hemoglobin in ND-CKD patients with no differences in adverse events over 6 months . It is unclear if the greater ferritin values in the IV iron sucrose group are clinical ly significant . Trial registration Clinical Trials.gov : BACKGROUND Although iron deficiency frequently complicates anemia in patients with nondialysis-dependent CKD ( ND-CKD ) , the comparative treatment value of IV iron infusion and oral iron supplementation has not been established . METHODS In a r and omized , controlled multicenter trial , we compared the efficacy of iron sucrose , given as 1 g in divided IV doses over 14 days , with that of ferrous sulfate , given 325 mg orally thrice daily for 56 days in patients with ND-CKD stages 3 to 5 , Hb < or = 11 g/dL , TSAT < or = 25 % , and ferritin < or = 300 ng/mL.  Epoetin/darbepoetin therapy , if any , was not changed for eight weeks prior to or during the study . RESULTS The proportion of patients achieving the primary outcome ( Hb increase > or = 1 g/dL ) was greater in the IV iron treatment group than in the oral iron treatment group ( 44.3 % vs. 28.0 % , P= 0.0344 ) , as was the mean increase in Hb by day 42 ( 0.7 vs. 0.4 g/dL , P= 0.0298 ) . Compared to those in the IV iron group , patients in the oral iron treatment group showed a greater decline in GFR during the study ( -4.40 vs. -1.45 mL/min/1.73m2 , P= 0.0100 ) . No serious adverse drug events ( ADE ) were seen in patients administered IV iron sucrose as 200 mg IV over two to five minutes , but drug-related hypotension , including one event considered serious , occurred in two females weighing less than 65 kg after 500 mg doses were given over four hours . CONCLUSION IV iron administration using 1000 mg iron sucrose in divided doses is superior to oral iron therapy in the management of ND-CKD patients with anemia and low iron indices Patients undergoing total hip or knee replacement frequently receive  blood transfusion . Homologous blood transfusion carries appreciable risks and should therefore be reduced to a minimum . We have investigated the use of preoperative oral iron supplements to optimize haemoglobin concentration and iron stores prior to surgery . All patients attending a preadmission clinic 4 weeks prior to primary hip or knee replacement had a haemoglobin measurement .  If the haemoglobin concentration ( Hb ) was less than 12 g dL-1 they were given a four week course of ferrous sulphate . If it was greater than or equal to 12 g dL-1 they were r and omized to a control group or given a supplementation course of ferrous sulphate .  One hundred patients were seen . Of these 18 ( 18 % ) had haemoglobin less than 12 g dL-1 and 16 were treated with iron . The mean Hb was 10.8 g dL-1 and mean cell volume ( MCV ) 86 . These patients increased their Hb by a mean 1.1 g dL-1 prior to admission ( P = 0.008 ) . MCV was the best predictor of response ( r = -0.63 , P < 0.02 ) . This group dropped their haemoglobin by a mean 1.4 g dL-1 in the first post-operative week . In the study groups there was no significant preoperative rise in Hb . However , the control group dropped their Hb by a mean 1.3 g dL-1 in the week following surgery compared with 0.4 g dL-1 in the group which had received iron supplements ( P < 0.001 ) . We conclude that at least 18 % of patients attending for hip or knee replacement in this region are frankly anaemic and benefit significantly from preoperative iron supplements over 4 weeks . Iron supplementation in patients without obvious anaemia protects against a fall in Hb during the immediate post-operative period , suggesting a widespread underlying depletion of iron stores in this group despite a normal Hb . Preoperative iron supplements may reduce transfusion requirements as part of a co-ordinated strategy in this group of patients Background : In patients with inflammatory bowel disease , oral iron is anecdotally reported to be less effective and less well tolerated than in those without inflammatory bowel disease , and to increase disease activity Background : Oral iron therapy is often used after orthopaedic surgery to improve haemoglobin levels . The aim of the present trial was to determine if administration of oral iron  after orthopaedic surgery results in a better improvement of haemoglobin levels than a control treatment BACKGROUND Anemia in heart failure patients and has been associated with increased morbi-mortality . Previous studies have treated anemia in heart failure patients with either erythropoietin alone or combination of erythropoietin and intravenous ( i.v . ) iron . However , the effect of i.v . or oral ( p.o . ) iron supplementation alone in heart failure patients with anemia was virtually unknown . AIM To compare , in a double-blind design , the effects of i.v . iron versus p.o . iron in anemic heart failure patients . METHODS IRON-HF study was a multicenter , investigator initiated , r and omized , double-blind , placebo controlled trial that enrolled anemic heart failure patients with preserved renal function , low transferrin saturation ( TSat ) and low-to-moderately elevated ferritin levels . Interventions were Iron Sucrose i.v . 200 mg , once a week , for 5 weeks , ferrous sulfate 200 mg p.o . TID , for 8 weeks , or placebo . Primary endpoint was variation of peak oxygen consumption ( peak VO2 ) assessed by ergospirometry over 3 month follow-up . RESULTS Eighteen patients had full follow-up data . There was an increment of 3.5 ml/kg/min in peak VO2 in the i.v . iron group . There was no increment in peak VO2 in the p.o . iron group . Patients ' ferritin and TSat increased significantly in both treated groups . Hemoglobin increased similarly in all groups . CONCLUSION I.v . iron seems to be superior in improving functional capacity  of heart failure patients . However , correction of anemia seems to be at least similar between p.o . iron 
    Output:
    
agent
There were no statistically significant differences in adverse effects , length of hospitalisation or mortality .
Conclusion Oral iron raises haemoglobin levels in elderly people with iron deficiency anaemia by 0.35 g/dL after 4–6 weeks , but it is unclear if this results in tangible health benefits
***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: 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 After total hip and knee replacement arthroplasty , patients may become anaemic and may be prescribed oral iron . There is , however , no published evidence that this is of benefit when used postoperatively . We treated 72 patients who were anaemic after primary total hip and knee arthroplasty by r and omly allocating them to receive six weeks of either oral ferrous sulphate ( 35 patients ) or a placebo ( 37 patients ) . Both groups of patients were similar in all aspects except for the treatment given . There was no statistically significant difference in the change of haemoglobin levels between the two groups . We therefore believe that the prescription of iron to all anaemic patients post-operatively should be avoided . The level of serum ferritin should be monitored at preoperative assessment Background Anaemia is a known risk factor for cardiovascular disease and treating anaemia in chronic kidney disease ( CKD ) may improve outcomes . However , little is known about the scope to improve primary care management of anaemia in CKD . Methods An observational study ( N = 1,099,292 ) with a nationally representative sample using anonymised routine primary care data from 127 Quality Improvement in CKD trial practice s ( IS RCT N5631023731 ) . We explored variables associated with anaemia in CKD : eGFR , haemoglobin ( Hb ) , mean corpuscular volume ( MCV ) , iron status , cardiovascular comorbidities , and use of therapy which associated with gastrointestinal bleeding , oral iron and deprivation score . We developed a linear regression model to identify variables amenable to improved primary care management . Results The prevalence of Stage 3–5 CKD was 6.76 % . Hb was lower in CKD ( 13.2 g/dl ) than without ( 13.7 g/dl ) . 22.2 % of people with CKD had World Health Organization defined anaemia ; 8.6 % had Hb ≤ 11 g/dl ; 3 % Hb ≤ 10 g/dl ; and 1 % Hb ≤ 9 g/dl . Normocytic anaemia was present in 80.5 % with Hb ≤ 11 ; 72.7 % with Hb ≤ 10 g/dl ; and 67.6 % with Hb ≤ 9 g/dl ; microcytic anaemia in 13.4 % with Hb ≤ 11 g/dl ; 20.8 % with Hb ≤ 10 g/dl ; and 24.9 % where Hb ≤ 9 g/dl . 82.7 % of people with microcytic and 58.8 % with normocytic anaemia ( Hb ≤ 11 g/dl ) had a low ferritin ( < 100ug/mL ) . Hypertension ( 67.2 % vs. 54 % ) and diabetes ( 30.7 % vs. 15.4 % ) were more prevalent in CKD and anaemia ; 61 % had been prescribed aspirin ; 73 % non-steroidal anti-inflammatory drugs ( NSAIDs ) ; 14.1 % warfarin 12.4 % clopidogrel ; and 53.1 % aspirin and NSAID . 56.3 % of people with CKD and anaemia had been prescribed oral iron . The main limitations of the study are that routine data are inevitably incomplete and definitions of anaemia have not been st and ardised . Conclusions Medication review is needed in people with CKD and anaemia prior to considering erythropoietin or parenteral iron . Iron stores may be depleted in over > 60 % of people with normocytic anaemia . Prescribing oral iron has not corrected anaemia Background Anemia secondary to iron deficiency is common in patients with non-dialysis dependent chronic kidney disease ( ND-CKD ) but it is unclear if oral supplementation is as effective as intravenous ( IV ) supplementation in re-establishing iron stores . The purpose of this study was to determine if oral Heme Iron Polypeptide ( HIP ) is as effective as IV iron sucrose in the treatment of iron-deficiency anemia for patients with ND-CKD . Methods Forty ND-CKD patients were r and omized ; 18 to HIP  11 mg orally 3 times per day and 22 to IV iron sucrose 200 mg monthly for 6 months . Baseline clinical and laboratory data were collected for all patients . The primary and secondary outcomes for the study were hemoglobin ( Hgb ) concentration and iron indices [ ferritin and percentage transferrin saturation ( TSAT ) ] at the end of 6 months respectively . Adverse events were also compared . Results The baseline demographic characteristics and laboratory values were similar for the two groups . After 6 months of treatment , Hb in the  HIP  group was 117 g/L and 113 g/L in the IV sucrose group ( p = 0.37 ) . The TSAT at 6 months was not different between the two groups { p = 0.82}but the serum ferritin was significantly higher in the IV iron sucrose group { 85.5 ug/L in HIP and 244 ug/L ; p = 0.004}. Overall adverse events were not different between the groups . Conclusion HIP is similar in efficacy to IV iron sucrose in maintaining hemoglobin in ND-CKD patients with no differences in adverse events over 6 months . It is unclear if the greater ferritin values in the IV iron sucrose group are clinical ly significant . Trial registration Clinical Trials.gov : BACKGROUND Although iron deficiency frequently complicates anemia in patients with nondialysis-dependent CKD ( ND-CKD ) , the comparative treatment value of IV iron infusion and oral iron supplementation has not been established . METHODS In a r and omized , controlled multicenter trial , we compared the efficacy of iron sucrose , given as 1 g in divided IV doses over 14 days , with that of ferrous sulfate , given 325 mg orally thrice daily for 56 days in patients with ND-CKD stages 3 to 5 , Hb < or = 11 g/dL , TSAT < or = 25 % , and ferritin < or = 300 ng/mL.  Epoetin/darbepoetin therapy , if any , was not changed for eight weeks prior to or during the study . RESULTS The proportion of patients achieving the primary outcome ( Hb increase > or = 1 g/dL ) was greater in the IV iron treatment group than in the oral iron treatment group ( 44.3 % vs. 28.0 % , P= 0.0344 ) , as was the mean increase in Hb by day 42 ( 0.7 vs. 0.4 g/dL , P= 0.0298 ) . Compared to those in the IV iron group , patients in the oral iron treatment group showed a greater decline in GFR during the study ( -4.40 vs. -1.45 mL/min/1.73m2 , P= 0.0100 ) . No serious adverse drug events ( ADE ) were seen in patients administered IV iron sucrose as 200 mg IV over two to five minutes , but drug-related hypotension , including one event considered serious , occurred in two females weighing less than 65 kg after 500 mg doses were given over four hours . CONCLUSION IV iron administration using 1000 mg iron sucrose in divided doses is superior to oral iron therapy in the management of ND-CKD patients with anemia and low iron indices Patients undergoing total hip or knee replacement frequently receive  blood transfusion . Homologous blood transfusion carries appreciable risks and should therefore be reduced to a minimum . We have investigated the use of preoperative oral iron supplements to optimize haemoglobin concentration and iron stores prior to surgery . All patients attending a preadmission clinic 4 weeks prior to primary hip or knee replacement had a haemoglobin measurement .  If the haemoglobin concentration ( Hb ) was less than 12 g dL-1 they were given a four week course of ferrous sulphate . If it was greater than or equal to 12 g dL-1 they were r and omized to a control group or given a supplementation course of ferrous sulphate .  One hundred patients were seen . Of these 18 ( 18 % ) had haemoglobin less than 12 g dL-1 and 16 were treated with iron . The mean Hb was 10.8 g dL-1 and mean cell volume ( MCV ) 86 . These patients increased their Hb by a mean 1.1 g dL-1 prior to admission ( P = 0.008 ) . MCV was the best predictor of response ( r = -0.63 , P < 0.02 ) . This group dropped their haemoglobin by a mean 1.4 g dL-1 in the first post-operative week . In the study groups there was no significant preoperative rise in Hb . However , the control group dropped their Hb by a mean 1.3 g dL-1 in the week following surgery compared with 0.4 g dL-1 in the group which had received iron supplements ( P < 0.001 ) . We conclude that at least 18 % of patients attending for hip or knee replacement in this region are frankly anaemic and benefit significantly from preoperative iron supplements over 4 weeks . Iron supplementation in patients without obvious anaemia protects against a fall in Hb during the immediate post-operative period , suggesting a widespread underlying depletion of iron stores in this group despite a normal Hb . Preoperative iron supplements may reduce transfusion requirements as part of a co-ordinated strategy in this group of patients Background : In patients with inflammatory bowel disease , oral iron is anecdotally reported to be less effective and less well tolerated than in those without inflammatory bowel disease , and to increase disease activity Background : Oral iron therapy is often used after orthopaedic surgery to improve haemoglobin levels . The aim of the present trial was to determine if administration of oral iron  after orthopaedic surgery results in a better improvement of haemoglobin levels than a control treatment BACKGROUND Anemia in heart failure patients and has been associated with increased morbi-mortality . Previous studies have treated anemia in heart failure patients with either erythropoietin alone or combination of erythropoietin and intravenous ( i.v . ) iron . However , the effect of i.v . or oral ( p.o . ) iron supplementation alone in heart failure patients with anemia was virtually unknown . AIM To compare , in a double-blind design , the effects of i.v . iron versus p.o . iron in anemic heart failure patients . METHODS IRON-HF study was a multicenter , investigator initiated , r and omized , double-blind , placebo controlled trial that enrolled anemic heart failure patients with preserved renal function , low transferrin saturation ( TSat ) and low-to-moderately elevated ferritin levels . Interventions were Iron Sucrose i.v . 200 mg , once a week , for 5 weeks , ferrous sulfate 200 mg p.o . TID , for 8 weeks , or placebo . Primary endpoint was variation of peak oxygen consumption ( peak VO2 ) assessed by ergospirometry over 3 month follow-up . RESULTS Eighteen patients had full follow-up data . There was an increment of 3.5 ml/kg/min in peak VO2 in the i.v . iron group . There was no increment in peak VO2 in the p.o . iron group . Patients ' ferritin and TSat increased significantly in both treated groups . Hemoglobin increased similarly in all groups . CONCLUSION I.v . iron seems to be superior in improving functional capacity  of heart failure patients . However , correction of anemia seems to be at least similar between p.o . iron 
    Output:
    