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Original article

Vol. 149 No. 2728 (2019)

Swiss Delphi study on iron deficiency

  • Albina Nowak
  • Anne Angelillo-Scherrer
  • Daniel Betticher
  • Michael Dickenmann
  • Idris Guessous
  • Pascal Juillerat
  • Wolfgang Korte
  • Stefan Neuner-Jehle
  • Otmar Pfister
  • Daniel Surbek
  • Edouard Battegay
  • Johann Steurer
DOI
https://doi.org/10.4414/smw.2019.20097
Cite this as:
Swiss Med Wkly. 2019;149:w20097
Published
03.07.2019

Summary

AIMS OF THE STUDY

Iron deficiency (ID) and iron deficiency anaemia (IDA) are important conditions affecting a large proportion of the general population, causing the patients physical and psychosomatic symptoms, particularly fatigue, and significantly affecting their quality of life. General practitioners (GPs) are frequently consulted with nonspecific symptoms due to the ID. However, little evidence is available to guide iron treatment. The aim of the Swiss Delphi study was to generate a broad consensual Swiss expert opinion in various therapeutic areas on diagnosis and treatment of ID/IDA and their practical implications.

METHODS

Specific statements regarding clinical relevance, practical diagnostic and therapeutic approaches, and treatment were evaluated by Swiss experts in various therapeutic areas using the Delphi method. “Consensus” was defined as ≥80% agreement; the agreement of 50–79% was defined as “critical”, of <50% as “disagreement”.

RESULTS

Consensus was reached for most statements. In patients without systemic inflammation, the threshold of 30 μg/l provide a good accuracy for the diagnosis of ID without anaemia. Ferritin levels within the range 30–50 μg/l with TSAT <20% can indicate ID without anaemia. Iron replacement therapy is accepted for treatment, not only of IDA, but also of symptomatic ID without anaemia. GPs play a central role in diagnosis and management of ID.

CONCLUSIONS

This consensus study provides potential therapeutic strategies for management of iron deficiency and is based on opinions of a high number of contributing specialists, providing their views from a wide range of clinical perspectives.

References

  1. Kassebaum NJ, Jasrasaria R, Naghavi M, Wulf SK, Johns N, Lozano R, et al. A systematic analysis of global anemia burden from 1990 to 2010. Blood. 2014;123(5):615–24. doi: https://doi.org/10.1182/blood-2013-06-508325
  2. Pasricha SR, Drakesmith H, Black J, Hipgrave D, Biggs BA. Control of iron deficiency anemia in low- and middle-income countries. Blood. 2013;121(14):2607–17. doi:.https://doi.org/10.1182/blood-2012-09-453522
  3. Levi M, Rosselli M, Simonetti M, Brignoli O, Cancian M, Masotti A, et al. Epidemiology of iron deficiency anaemia in four European countries: a population-based study in primary care. Eur J Haematol. 2016;97(6):583–93. doi:.https://doi.org/10.1111/ejh.12776
  4. Klip IT, Comin-Colet J, Voors AA, Ponikowski P, Enjuanes C, Banasiak W, et al. Iron deficiency in chronic heart failure: an international pooled analysis. Am Heart J. 2013;165(4):575–582.e3. doi:.https://doi.org/10.1016/j.ahj.2013.01.017
  5. Stoltzfus RJ. Iron deficiency: global prevalence and consequences. Food Nutr Bull. 2003;24(4, Suppl):S99–103. doi:.https://doi.org/10.1177/15648265030244S106
  6. Lopez A, Cacoub P, Macdougall IC, Peyrin-Biroulet L. Iron deficiency anaemia. Lancet. 2016;387(10021):907–16. doi:.https://doi.org/10.1016/S0140-6736(15)60865-0
  7. Kasner M, Aleksandrov AS, Westermann D, Lassner D, Gross M, von Haehling S, et al. Functional iron deficiency and diastolic function in heart failure with preserved ejection fraction. Int J Cardiol. 2013;168(5):4652–7. doi:.https://doi.org/10.1016/j.ijcard.2013.07.185
  8. Enjuanes C, Klip IT, Bruguera J, Cladellas M, Ponikowski P, Banasiak W, et al. Iron deficiency and health-related quality of life in chronic heart failure: results from a multicenter European study. Int J Cardiol. 2014;174(2):268–75. doi:.https://doi.org/10.1016/j.ijcard.2014.03.169
  9. Fishbane S, Spinowitz B. Update on Anemia in ESRD and Earlier Stages of CKD: Core Curriculum 2018. Am J Kidney Dis. 2018;71(3):423–35. doi:.https://doi.org/10.1053/j.ajkd.2017.09.026
  10. Pengelly S, Fabricius M, McMenamin D, Wu E, Metzner M, Lewis SJ, et al. Attendance at iron deficiency anaemia clinic: audit of outcomes 5 years on. Colorectal Dis. 2013;15(4):423–7. doi:.https://doi.org/10.1111/codi.12040
  11. Dignass AU, Gasche C, Bettenworth D, Birgegård G, Danese S, Gisbert JP, et al.; European Crohn’s and Colitis Organisation [ECCO]. European consensus on the diagnosis and management of iron deficiency and anaemia in inflammatory bowel diseases. J Crohn’s Colitis. 2015;9(3):211–22. doi:.https://doi.org/10.1093/ecco-jcc/jju009
  12. Evstatiev R, Alexeeva O, Bokemeyer B, Chopey I, Felder M, Gudehus M, et al.; FERGI Study Group. Ferric carboxymaltose prevents recurrence of anemia in patients with inflammatory bowel disease. Clin Gastroenterol Hepatol. 2013;11(3):269–77. doi:.https://doi.org/10.1016/j.cgh.2012.10.013
  13. Stein J, Connor S, Virgin G, Ong DE, Pereyra L. Anemia and iron deficiency in gastrointestinal and liver conditions. World J Gastroenterol. 2016;22(35):7908–25. doi:.https://doi.org/10.3748/wjg.v22.i35.7908
  14. Houston BL, Hurrie D, Graham J, Perija B, Rimmer E, Rabbani R, et al. Efficacy of iron supplementation on fatigue and physical capacity in non-anaemic iron-deficient adults: a systematic review of randomised controlled trials. BMJ Open. 2018;8(4):e019240. doi:.https://doi.org/10.1136/bmjopen-2017-019240
  15. Krayenbuehl PA, Battegay E, Breymann C, Furrer J, Schulthess G. Intravenous iron for the treatment of fatigue in nonanemic, premenopausal women with low serum ferritin concentration. Blood. 2011;118(12):3222–7. doi:.https://doi.org/10.1182/blood-2011-04-346304
  16. Haas JD, Brownlie T, 4th. Iron deficiency and reduced work capacity: a critical review of the research to determine a causal relationship. J Nutr. 2001;131(2):676S–88S, discussion 688S–90S. doi:.https://doi.org/10.1093/jn/131.2.676S
  17. van Veldhuisen DJ, Ponikowski P, van der Meer P, Metra M, Böhm M, Doletsky A, et al.; EFFECT-HF Investigators. Effect of Ferric Carboxymaltose on Exercise Capacity in Patients With Chronic Heart Failure and Iron Deficiency. Circulation. 2017;136(15):1374–83. doi:.https://doi.org/10.1161/CIRCULATIONAHA.117.027497
  18. Anker SD, Comin Colet J, Filippatos G, Willenheimer R, Dickstein K, Drexler H, et al.; FAIR-HF Trial Investigators. Ferric carboxymaltose in patients with heart failure and iron deficiency. N Engl J Med. 2009;361(25):2436–48. doi:.https://doi.org/10.1056/NEJMoa0908355
  19. Viveky N, Toffelmire L, Thorpe L, Billinsky J, Alcorn J, Hadjistavropoulos T, et al. Use of vitamin and mineral supplements in long-term care home residents. Appl Physiol Nutr Metab. 2012;37(1):100–5. doi:.https://doi.org/10.1139/h11-141
  20. Biétry FA, Hug B, Reich O, Susan JS, Meier CR. Iron supplementation in Switzerland - A bi-national, descriptive and observational study. Swiss Med Wkly. 2017;147:w14444. doi:.https://doi.org/10.4414/smw.2017.14444
  21. Taylor RM, Fealy SM, Bisquera A, Smith R, Collins CE, Evans TJ, et al. Effects of Nutritional Interventions during Pregnancy on Infant and Child Cognitive Outcomes: A Systematic Review and Meta-Analysis. Nutrients. 2017;9(11):1265. doi:.https://doi.org/10.3390/nu9111265
  22. Low MS, Speedy J, Styles CE, De-Regil LM, Pasricha SR. Daily iron supplementation for improving anaemia, iron status and health in menstruating women. Cochrane Database Syst Rev. 2016;4:CD009747. doi:.https://doi.org/10.1002/14651858.CD009747.pub2
  23. Diamond IR, Grant RC, Feldman BM, Pencharz PB, Ling SC, Moore AM, et al. Defining consensus: a systematic review recommends methodologic criteria for reporting of Delphi studies. J Clin Epidemiol. 2014;67(4):401–9. doi:.https://doi.org/10.1016/j.jclinepi.2013.12.002
  24. Boulkedid R, Abdoul H, Loustau M, Sibony O, Alberti C. Using and reporting the Delphi method for selecting healthcare quality indicators: a systematic review. PLoS One. 2011;6(6):e20476. doi:.https://doi.org/10.1371/journal.pone.0020476
  25. Mullen PM. Delphi: myths and reality. J Health Organ Manag. 2003;17(1):37–52. doi:.https://doi.org/10.1108/14777260310469319
  26. Doumit G, Gattellari M, Grimshaw J, O’Brien MA. Local opinion leaders: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2007;(1):CD000125.
  27. Ponikowski P, van Veldhuisen DJ, Comin-Colet J, Ertl G, Komajda M, Mareev V, et al.; CONFIRM-HF Investigators. Beneficial effects of long-term intravenous iron therapy with ferric carboxymaltose in patients with symptomatic heart failure and iron deficiency. Eur Heart J. 2015;36(11):657–68. doi:.https://doi.org/10.1093/eurheartj/ehu385
  28. Armuzzi A, Felice C, Lubrano E, Cantini F, Castiglione F, Gionchetti P, et al.; Italian SpA-IBD Expert Panel Group. Multidisciplinary management of patients with coexisting inflammatory bowel disease and spondyloarthritis: A Delphi consensus among Italian experts. Dig Liver Dis. 2017;49(12):1298–305. doi:.https://doi.org/10.1016/j.dld.2017.06.004
  29. Rahaghi FF, Feldman JP, Allen RP, Tapson V, Safdar Z, Balasubramanian VP, et al. Recommendations for the use of oral treprostinil in clinical practice: a Delphi consensus project pulmonary circulation. Pulm Circ. 2017;7(1):167–74. doi:.https://doi.org/10.1086/690109
  30. Colonna P, Andreotti F, Ageno W, Pengo V, Marchionni N. Clinical conundrums in antithrombotic therapy management: A Delphi Consensus panel. Int J Cardiol. 2017;249:249–56. doi:.https://doi.org/10.1016/j.ijcard.2017.09.159
  31. Blumberg JB, Cena H, Barr SI, Biesalski HK, Dagach RU, Delaney B, et al. The Use of Multivitamin/Multimineral Supplements: A Modified Delphi Consensus Panel Report. Clin Ther. 2018;40(4):640–57. doi:.https://doi.org/10.1016/j.clinthera.2018.02.014
  32. Mast AE, Blinder MA, Gronowski AM, Chumley C, Scott MG. Clinical utility of the soluble transferrin receptor and comparison with serum ferritin in several populations. Clin Chem. 1998;44(1):45–51.
  33. Peyrin-Biroulet L, Williet N, Cacoub P. Guidelines on the diagnosis and treatment of iron deficiency across indications: a systematic review. Am J Clin Nutr. 2015;102(6):1585–94. doi:.https://doi.org/10.3945/ajcn.114.103366
  34. Locatelli F, Bárány P, Covic A, De Francisco A, Del Vecchio L, Goldsmith D, et al.; ERA-EDTA ERBP Advisory Board. Kidney Disease: Improving Global Outcomes guidelines on anaemia management in chronic kidney disease: a European Renal Best Practice position statement. Nephrol Dial Transplant. 2013;28(6):1346–59. doi:.https://doi.org/10.1093/ndt/gft033
  35. Bager P, Dahlerup JF. Randomised clinical trial: oral vs. intravenous iron after upper gastrointestinal haemorrhage--a placebo-controlled study. Aliment Pharmacol Ther. 2014;39(2):176–87. doi:.https://doi.org/10.1111/apt.12556
  36. Waldvogel S, Pedrazzini B, Vaucher P, Bize R, Cornuz J, Tissot JD, et al. Clinical evaluation of iron treatment efficiency among non-anemic but iron-deficient female blood donors: a randomized controlled trial. BMC Med. 2012;10(1):8. doi:.https://doi.org/10.1186/1741-7015-10-8
  37. Ludwig H, Müldür E, Endler G, Hübl W. Prevalence of iron deficiency across different tumors and its association with poor performance status, disease status and anemia. Ann Oncol. 2013;24(7):1886–92. doi:.https://doi.org/10.1093/annonc/mdt118
  38. Drüeke TB, Parfrey PS. Summary of the KDIGO guideline on anemia and comment: reading between the (guide)line(s). Kidney Int. 2012;82(9):952–60. doi:.https://doi.org/10.1038/ki.2012.270
  39. National Comprehensive Cancer Network Inc. NCCN Practice Guidelines in Oncology; Cancer and Chemotherapy-Induced Anemia 2016.
  40. Jankowska EA, Rozentryt P, Witkowska A, Nowak J, Hartmann O, Ponikowska B, et al. Iron deficiency: an ominous sign in patients with systolic chronic heart failure. Eur Heart J. 2010;31(15):1872–80. doi:.https://doi.org/10.1093/eurheartj/ehq158
  41. KDIGO Clinical Practice Guideline for Anemia in Chronic Kidney Disease. 2012. http://www.kidney-international.org.
  42. KDIGO. KDIGO clinical practice guideline for anemia in chronic kidney disease. Kidney Int. 2012;2(4):279–335.
  43. Macdougall IC. Iron Treatment Strategies in Nondialysis CKD. Semin Nephrol. 2016;36(2):99–104. doi:.https://doi.org/10.1016/j.semnephrol.2016.02.003
  44. Breymann C, Honegger C, Holzgreve W, Surbek D. Diagnosis and treatment of iron-deficiency anaemia during pregnancy and postpartum. Arch Gynecol Obstet. 2010;282(5):577–80. doi:.https://doi.org/10.1007/s00404-010-1532-z
  45. Lewis GD, Malhotra R, Hernandez AF, McNulty SE, Smith A, Felker GM, et al.; NHLBI Heart Failure Clinical Research Network. Effect of Oral Iron Repletion on Exercise Capacity in Patients With Heart Failure With Reduced Ejection Fraction and Iron Deficiency: The IRONOUT HF Randomized Clinical Trial. JAMA. 2017;317(19):1958–66. doi:.https://doi.org/10.1001/jama.2017.5427

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