{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T14:51:15Z","timestamp":1790866275175,"version":"4.1.0"},"reference-count":17,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Optimal oral iron supplementation strategy is unclear in patients with iron deficiency anemia (IDA) who have either normal kidney function (NKF) or chronic kidney disease (CKD).<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To investigate the association of different oral iron supplementation strategies with the change in hemoglobin and iron indices among patients with IDA with either NKF or CKD.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n \n This retrospective cohort study was conducted between 2009 and 2019 at nationwide Veterans Health Administration facilities. Eligible participants included veterans with IDA (defined as hemoglobin &amp;lt;12 g\/dL and either iron saturation &amp;lt;20% or ferritin &amp;lt;50 ng\/mL) who received their first outpatient prescription of oral iron. Patients were further divided into those with NKF (estimated glomerular filtration rate &amp;gt;60 mL\/min\/1.73 m\n 2<\/jats:sup>\n ) and CKD (estimated glomerular filtration rate \u226515 mL\/min\/1.73 m\n 2<\/jats:sup>\n and &amp;lt;60 mL\/min\/1.73 m\n 2<\/jats:sup>\n ). Data analysis was conducted from February to October 2023.\n <\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n Patients were classified into 3 groups based on their oral iron dosing schedule: daily (once a day), multiple doses per day (MDD; \u22652 times per day), or alternate-day dose (ADD).<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcomes were change of hemoglobin, ferritin, total iron binding capacity (TIBC), and iron saturation (ISAT), which were calculated with linear mixed-effects models.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 71\u202f677 veterans with IDA (63\u202f202 male [88.2%] and 8475 female [11.8%]; mean [SD] age, 68.47 [13.09] years), including 47\u202f201 with NKF and 24\u202f476 with CKD, were identifed. In patients with NKF in the daily group, hemoglobin increased from baseline (estimated per-30-day difference [SE], 0.27 [0.00] g\/dL;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001). In comparison with the daily group, hemoglobin increased more in the MDD group (estimated per-30-day difference [SE], 0.08 [0.03] g\/dL;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001), but no difference was noted in the ADD group (estimated per-30-day difference [SE], \u22120.01 [0.01] g\/dL;\n P<\/jats:italic>\n \u2009=\u2009.38). Ferritin, ISAT, and TIBC results were similar, except TIBC showed less change in the ADD group compared with the daily group. Patients with CKD showed similar trends but smaller magnitudes in changes. Among patients with NKF, the adjusted mean increase in hemoglobin was 1.03 g\/dL (95% CI, 1.01-1.06 g\/dL) for those in the daily group, 1.38 g\/dL (95% CI, 1.36-1.40 g\/dL) for those in the MDD group, and 0.93 g\/dL (95% CI, 0.84-1.02 g\/dL) for those in the ADD group at 90 days. Among patients with CKD, the adjusted mean increase in hemoglobin was 0.71 g\/dL (95% CI, 0.68-0.73 g\/dL) for those in the daily group, 0.99 g\/dL (95% CI, 0.97-1.01 g\/dL) for those in the MDD group, and 0.62 g\/dL (95% CI, 0.52-0.73 g\/dL) for those in the ADD group at 90 days.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this retrospective cohort study of veterans with IDA, there was no significant difference in the improvement of hemoglobin and iron indices between daily and ADD groups, but quickest improvement was observed in the MDD group. These findings suggest that the choice of oral iron therapy should depend on the rapidity of response desired and patient preference due to adverse effects.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.14305","type":"journal-article","created":{"date-parts":[[2024,5,31]],"date-time":"2024-05-31T11:33:06Z","timestamp":1717155186000},"page":"e2414305","source":"Crossref","is-referenced-by-count":6,"title":["Optimal Oral Iron Therapy for Iron Deficiency Anemia Among US Veterans"],"prefix":"10.1001","volume":"7","author":[{"given":"Nilang","family":"Patel","sequence":"first","affiliation":[{"name":"Department of Medicine, Virginia Commonwealth University, Richmond"},{"name":"Division of Nephrology, Central Virginia VA Healthcare System, Richmond"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott G.","family":"Silvey","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Central Virginia VA Healthcare System, Richmond"},{"name":"Department of Biostatistics Virginia Commonwealth University, Richmond"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pradeep","family":"Arora","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Buffalo, Buffalo, New York"},{"name":"Division of Nephrology, VA Western New York Healthcare System, Buffalo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George M.","family":"Feldman","sequence":"additional","affiliation":[{"name":"Department of Medicine, Virginia Commonwealth University, Richmond"},{"name":"Division of Nephrology, Central Virginia VA Healthcare System, Richmond"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2024,5,31]]},"reference":[{"issue":"1","key":"zoi240487r1","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1093\/ajcn\/62.1.117","article-title":"Efficacy of weekly compared with daily iron supplementation.","volume":"62","author":"Cook","year":"1995","journal-title":"Am J Clin Nutr"},{"issue":"1","key":"zoi240487r2","doi-asserted-by":"publisher","first-page":"315","DOI":"10.1182\/hematology.2019000034","article-title":"Management of iron deficiency.","volume":"2019","author":"Ning","year":"2019","journal-title":"Hematology Am Soc Hematol Educ Program"},{"issue":"2","key":"zoi240487r3","first-page":"98","article-title":"Iron deficiency anemia: evaluation and management.","volume":"87","author":"Short","year":"2013","journal-title":"Am Fam Physician"},{"issue":"10021","key":"zoi240487r4","doi-asserted-by":"publisher","first-page":"907","DOI":"10.1016\/S0140-6736(15)60865-0","article-title":"Iron deficiency anaemia.","volume":"387","author":"Lopez","year":"2016","journal-title":"Lancet"},{"issue":"9","key":"zoi240487r5","doi-asserted-by":"publisher","first-page":"1434","DOI":"10.1016\/j.bbamcr.2012.01.014","article-title":"Hepcidin and iron homeostasis.","volume":"1823","author":"Ganz","year":"2012","journal-title":"Biochim Biophys Acta"},{"issue":"17","key":"zoi240487r6","doi-asserted-by":"publisher","first-page":"1981","DOI":"10.1182\/blood-2015-05-642223","article-title":"Oral iron supplements increase hepcidin and decrease iron absorption from daily or twice-daily doses in iron-depleted young women.","volume":"126","author":"Moretti","year":"2015","journal-title":"Blood"},{"issue":"9","key":"zoi240487r7","doi-asserted-by":"publisher","first-page":"2261","DOI":"10.1016\/j.ekir.2021.05.020","article-title":"Treatment of iron deficiency anemia in CKD and end-stage kidney disease.","volume":"6","author":"Guti\u00e9rrez","year":"2021","journal-title":"Kidney Int Rep"},{"issue":"9","key":"zoi240487r8","doi-asserted-by":"publisher","first-page":"976","DOI":"10.1038\/ki.2009.21","article-title":"Plasma hepcidin levels are elevated but responsive to erythropoietin therapy in renal disease.","volume":"75","author":"Ashby","year":"2009","journal-title":"Kidney Int"},{"issue":"4","key":"zoi240487r9","doi-asserted-by":"publisher","first-page":"292","DOI":"10.1038\/kisup.2012.34","article-title":"Chapter 2: Use of iron to treat anemia in CKD. 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