---
title: "Intravenous Iron in Chronic Kidney Disease: Potential Effects on Survival, Heart Failure, and Phys"
id: "pubmed-42640172"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42640172"
content_type: "clinical_feed_article"
specialty: "Pharmacology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42640172/"
doi: "10.1056/EVIDtt2600064"
published_at: "2026-08-25T12:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Intravenous Iron in Chronic Kidney Disease: Potential Effects on Survival, Heart Failure, and Phys
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42640172
- **Specialty:** [Pharmacology](https://medichelpline.com/clinical-feed/pharmacology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42640172/)
- **DOI:** [10.1056/EVIDtt2600064](https://doi.org/10.1056%2FEVIDtt2600064)
- **Published At:** 2026-08-25T12:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- Iron deficiency is common in patients with **chronic kidney disease (CKD)** and frequently coexists with anemia. Current guideline recommendations generally limit iron therapy to patients who are anemic. - Patients with CKD have an increased risk of **heart failure**, and when heart failure and iron deficiency coexist outcomes are worse than with either condition alone, including worse quality of life, reduced physical function, and higher mortality. - The article reviews available evidence for the use of **intravenous iron** in populations with CKD and in patients with heart failure, noting overlaps in pathophysiology and potential for shared therapeutic benefit. - Existing evidence and guidelines focus largely on treating iron deficiency in the context of anemia; there is limited direct evidence evaluating intravenous iron given independent of hemoglobin level in CKD. - The authors propose conducting a randomized controlled trial of **intravenous iron**, administered irrespective of baseline hemoglobin, to evaluate effects on hard clinical outcomes: **mortality**, heart-failure events, and **physical function**. - Details on trial design are discussed conceptually in the article; specific trial parameters, sample size, and results are not reported in the PubMed abstract. - The review highlights the need to fill evidence gaps about whether treating iron deficiency alone (without requiring anemia) can improve clinically meaningful outcomes in CKD patients at high cardiovascular risk.
## Clinical Analysis & Structured Key Points
Clipboard, Search History, and several other advanced features are temporarily unavailable. [ Skip to main page content ](https://pubmed.ncbi.nlm.nih.gov/42640172/#article-details) ![U.S. flag](https://cdn.ncbi.nlm.nih.gov/coreutils/uswds/img/favicons/favicon-57.png) An official website of the United States government Here's how you know ![Dot gov](https://cdn.ncbi.nlm.nih.gov/coreutils/uswds/img/icon-dot-gov.svg) **The .gov means it’s official.** Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site. ![Https](https://cdn.ncbi.nlm.nih.gov/coreutils/uswds/img/icon-https.svg) **The site is secure.** The **https://** ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. [ ![NIH NLM Logo](https://cdn.ncbi.nlm.nih.gov/coreutils/nwds/img/logos/AgencyLogo.svg) ](https://www.ncbi.nlm.nih.gov/) [Log in](https://account.ncbi.nlm.nih.gov/?back_url=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F42640172%2F) Show account info Close #### Account Logged in as: **username** * [Dashboard](https://www.ncbi.nlm.nih.gov/myncbi/) * [Publications](https://www.ncbi.nlm.nih.gov/myncbi/collections/bibliography/) * [Account settings](https://www.ncbi.nlm.nih.gov/account/settings/) * [Log out](https://www.ncbi.nlm.nih.gov/account/signout/?back_url=https%3A//pubmed.ncbi.nlm.nih.gov/42640172/) [Access keys](https://www.ncbi.nlm.nih.gov/guide/browsers/#ncbi_accesskeys) [NCBI Homepage](https://www.ncbi.nlm.nih.gov) [MyNCBI Homepage](https://pubmed.ncbi.nlm.nih.gov/myncbi/) [Main Content](https://pubmed.ncbi.nlm.nih.gov/42640172/#maincontent) [Main Navigation](https://pubmed.ncbi.nlm.nih.gov/42640172/) [ ![pubmed logo](https://cdn.ncbi.nlm.nih.gov/pubmed/af7de7da-df5d-41c6-8de4-8c266af8ccfb/core/images/pubmed-logo-blue.svg) ](https://pubmed.ncbi.nlm.nih.gov/) [ ](https://pubmed.ncbi.nlm.nih.gov/42640172/ "Show search bar") Search: [](https://pubmed.ncbi.nlm.nih.gov/42640172/ "Clear search input")Search [Advanced](https://pubmed.ncbi.nlm.nih.gov/advanced/) [ Clipboard ](https://pubmed.ncbi.nlm.nih.gov/clipboard/) [ User Guide ](https://pubmed.ncbi.nlm.nih.gov/help/) Save Email Send to * [ Clipboard ](https://pubmed.ncbi.nlm.nih.gov/42640172/) * [My Bibliography](https://account.ncbi.nlm.nih.gov/?back_url=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F42640172%2F%23open-bibliography-panel) * [Collections](https://account.ncbi.nlm.nih.gov/?back_url=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F42640172%2F%23open-collections-panel) * [Citation manager](https://pubmed.ncbi.nlm.nih.gov/42640172/) Display options Display options Format Abstract PubMed PMID ## Save citation to file Format: Summary (text) PubMed PMID Abstract (text) CSV Create file Cancel ## Email citation Email address has not been verified. Go to [ My NCBI account settings ](https://account.ncbi.nlm.nih.gov/settings/) to confirm your email and then refresh this page. To: Subject: Body: Format: Summary Summary (text) Abstract Abstract (text) MeSH and other data Send email Cancel ### Add to Collections * Create a new collection * Add to an existing collection Name your collection: Name must be less than 100 characters Choose a collection: Unable to load your collection due to an error [Please try again](https://pubmed.ncbi.nlm.nih.gov/42640172/) Add Cancel ### Add to My Bibliography * My Bibliography Unable to load your delegates due to an error [Please try again](https://pubmed.ncbi.nlm.nih.gov/42640172/) Add Cancel ## Your saved search Name of saved search: Search terms: [Test search terms](https://pubmed.ncbi.nlm.nih.gov/42640172/) Would you like email updates of new search results? Saved Search Alert Radio Buttons * Yes * No Email: ([change](https://www.ncbi.nlm.nih.gov/account/settings/)) Frequency: Monthly Weekly Daily Which day? The first Sunday The first Monday The first Tuesday The first Wednesday The first Thursday The first Friday The first Saturday The first day The first weekday Which day? Sunday Monday Tuesday Wednesday Thursday Friday Saturday Report format: Summary Summary (text) Abstract Abstract (text) PubMed Send at most: 1 item 5 items 10 items 20 items 50 items 100 items 200 items Send even when there aren't any new results Optional text in email: Save Cancel ## Create a file for external citation management software Create file Cancel ## Your RSS Feed Name of RSS Feed: Number of items displayed: 5 10 15 20 50 100 Create RSS Cancel RSS Link Copy ### Actions Cite Collections Add to Collections * Create a new collection * Add to an existing collection Name your collection: Name must be less than 100 characters Choose a collection: Unable to load your collection due to an error [Please try again](https://pubmed.ncbi.nlm.nih.gov/42640172/) Add Cancel Permalink Permalink Copy Display options Display options Format Abstract PubMed PMID ### Page navigation * [ Title & authors ](https://pubmed.ncbi.nlm.nih.gov/42640172/#heading) * [ Abstract ](https://pubmed.ncbi.nlm.nih.gov/42640172/#abstract) * [ Publication types ](https://pubmed.ncbi.nlm.nih.gov/42640172/#publication-types) * [ MeSH terms ](https://pubmed.ncbi.nlm.nih.gov/42640172/#mesh-terms) * [ Substances ](https://pubmed.ncbi.nlm.nih.gov/42640172/#substances) Title & authors Abstract Publication types MeSH terms Substances Review NEJM Evid Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22NEJM+Evid%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22NEJM+Evid%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42640172/) . 2026 Sep;5(9):EVIDtt2600064. doi: 10.1056/EVIDtt2600064. Epub 2026 Aug 25. # Does Intravenous Iron Improve Survival and Physical Function and Reduce Heart Failure Events in Patients with Chronic Kidney Disease? [Brendon L Neuen](https://pubmed.ncbi.nlm.nih.gov/?term=Neuen+BL&cauthor_id=42640172)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42640172/#full-view-affiliation-1 "The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42640172/#full-view-affiliation-2 "Department of Renal Medicine, Royal North Shore Hospital, Sydney, NSW, Australia."), [Adeera Levin](https://pubmed.ncbi.nlm.nih.gov/?term=Levin+A&cauthor_id=42640172)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42640172/#full-view-affiliation-3 "Division of Nephrology, The University of British Columbia, Vancouver, BC, Canada.")[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42640172/#full-view-affiliation-4 "Division of Nephrology, St Paul's Hospital, Vancouver, BC, Canada.") Affiliations Expand ### Affiliations * 1 The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia. * 2 Department of Renal Medicine, Royal North Shore Hospital, Sydney, NSW, Australia. * 3 Division of Nephrology, The University of British Columbia, Vancouver, BC, Canada. * 4 Division of Nephrology, St Paul's Hospital, Vancouver, BC, Canada. * PMID: **42640172** * DOI: [ 10.1056/EVIDtt2600064 ](https://doi.org/10.1056/evidtt2600064) Item in Clipboard Review # Does Intravenous Iron Improve Survival and Physical Function and Reduce Heart Failure Events in Patients with Chronic Kidney Disease? Brendon L Neuen et al. NEJM Evid. 2026 Sep. Show details Display options Display options Format Abstract PubMed PMID NEJM Evid Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22NEJM+Evid%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22NEJM+Evid%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42640172/) . 2026 Sep;5(9):EVIDtt2600064. doi: 10.1056/EVIDtt2600064. Epub 2026 Aug 25. ### Authors [Brendon L Neuen](https://pubmed.ncbi.nlm.nih.gov/?term=Neuen+BL&cauthor_id=42640172)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42640172/#short-view-affiliation-1 "The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42640172/#short-view-affiliation-2 "Department of Renal Medicine, Royal North Shore Hospital, Sydney, NSW, Australia."), [Adeera Levin](https://pubmed.ncbi.nlm.nih.gov/?term=Levin+A&cauthor_id=42640172)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42640172/#short-view-affiliation-3 "Division of Nephrology, The University of British Columbia, Vancouver, BC, Canada.")[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42640172/#short-view-affiliation-4 "Division of Nephrology, St Paul's Hospital, Vancouver, BC, Canada.") ### Affiliations * 1 The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia. * 2 Department of Renal Medicine, Royal North Shore Hospital, Sydney, NSW, Australia. * 3 Division of Nephrology, The University of British Columbia, Vancouver, BC, Canada. * 4 Division of Nephrology, St Paul's Hospital, Vancouver, BC, Canada. * PMID: **42640172** * DOI: [ 10.1056/EVIDtt2600064 ](https://doi.org/10.1056/evidtt2600064) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract AbstractIron deficiency is common in patients with chronic kidney disease (CKD). Contemporary guidelines recommend the use of iron therapy only in the presence of anemia. However, patients with CKD are at increased risk of heart failure, and the coexistence of both conditions is associated with impaired quality of life, reduced physical function, and increased mortality compared with either condition alone. In this Tomorrow's Trial article, we review current evidence for intravenous iron in CKD and heart failure and propose the design of a randomized trial of intravenous iron, independent of hemoglobin, to assess its effects on mortality, heart failure, and physical function. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Publication types * Review Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Review%22%5Bpt%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Review) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42640172/) ## MeSH terms * Administration, Intravenous Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Administration%2C+Intravenous%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Administration%2C+Intravenous) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42640172/) * Anemia, Iron-Deficiency* / complications Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Anemia%2C+Iron-Deficiency%2Fcomplications%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Anemia%2C+Iron-Deficiency) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42640172/) * Anemia, Iron-Deficiency* / drug therapy Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Anemia%2C+Iron-Deficiency%2Fdrug+therapy%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Anemia%2C+Iron-Deficiency) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42640172/) * Heart Failure* / mortality Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Heart+Failure%2Fmortality%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Heart+Failure) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42640172/) * Heart Failure* / prevention & control Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Heart+Failure%2Fprevention+and+control%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Heart+Failure) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42640172/) * Humans Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Humans%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Humans) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42640172/) * Iron* / administration & dosage Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Iron%2Fadministration+and+dosage%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Iron) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42640172/) * Iron* / therapeutic use Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Iron%2Ftherapeutic+use%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Iron) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42640172/) * Quality of Life Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Quality+of+Life%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Quality+of+Life) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42640172/) * Randomized Controlled Trials as Topic Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Randomized+Controlled+Trials+as+Topic%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Randomized+Controlled+Trials+as+Topic) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42640172/) * Renal Insufficiency, Chronic* / complications Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Renal+Insufficiency%2C+Chronic%2Fcomplications%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Renal+Insufficiency%2C+Chronic) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42640172/) ## Substances * Iron Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Iron%22%5Bnm%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=%22Iron%22) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42640172/) [x] Cite Copy Download .nbib .nbib Format: AMA APA MLA NLM **Send To** * [Clipboard](https://pubmed.ncbi.nlm.nih.gov/42640172/) * [Email](https://account.ncbi.nlm.nih.gov/?back_url=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F42640172%2F%23open-email-panel) * [Save](https://pubmed.ncbi.nlm.nih.gov/42640172/) * [My Bibliography](https://account.ncbi.nlm.nih.gov/?back_url=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F42640172%2F%23open-bibliography-panel) * [Collections](https://account.ncbi.nlm.nih.gov/?back_url=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F42640172%2F%23open-collections-panel) * [Citation Manager](https://pubmed.ncbi.nlm.nih.gov/42640172/) [x] NCBI Literature Resources [MeSH](https://www.ncbi.nlm.nih.gov/mesh/) [PMC](https://www.ncbi.nlm.nih.gov/pmc/) [Bookshelf](https://www.ncbi.nlm.nih.gov/books) [Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unauthorized use of these marks is strictly prohibited. Follow NCBI [ Twitter ](https://twitter.com/ncbi) [ Facebook ](https://www.facebook.com/ncbi.nlm) [ LinkedIn ](https://www.linkedin.com/company/ncbinlm) [ GitHub ](https://github.com/ncbi) [ ](https://ncbiinsights.ncbi.nlm.nih.gov/) [Connect with NLM](https://www.nlm.nih.gov/socialmedia/index.html) * [ Twitter ](https://twitter.com/NLM_NIH) * [ SM-Facebook ](https://www.facebook.com/nationallibraryofmedicine) * [ SM-Youtube ](https://www.youtube.com/user/NLMNIH) National Library of Medicine [8600 Rockville Pike Bethesda, MD 20894](https://www.google.com/maps/place/8600+Rockville+Pike,+Bethesda,+MD+20894/@38.9959508,-77.101021,17z/data=!3m1!4b1!4m5!3m4!1s0x89b7c95e25765ddb:0x19156f88b27635b8!8m2!3d38.9959508!4d-77.0988323) [Web Policies](https://www.nlm.nih.gov/web_policies.html) [FOIA](https://www.nih.gov/institutes-nih/nih-office-director/office-communications-public-liaison/freedom-information-act-office) [HHS Vulnerability Disclosure](https://www.hhs.gov/vulnerability-disclosure-policy/index.html) [Help](https://support.nlm.nih.gov/?pagename=pubmed%3Apubmed%3Aabstract%3ANONE) [Accessibility](https://www.nlm.nih.gov/accessibility.html) [Careers](https://www.nlm.nih.gov/careers/careers.html) * [NLM](https://www.nlm.nih.gov/) * [NIH](https://www.nih.gov/) * [HHS](https://www.hhs.gov/) * [USA.gov](https://www.usa.gov/)
## Related Clinical Research

- [SGLT2 inhibitors and urinary tract infection risk: trial-level meta-analysis across T2D, HF, and C](https://medichelpline.com/clinical-feed/pubmed-42566081.md) (DOI: 10.1007/s40199-026-00637-7)
- [Kidney‑conditioned urinary peptidomic ageing clock predicts mortality and age‑related outcomes](https://medichelpline.com/clinical-feed/medrxiv-7-a-kidney-conditioned-urinary-peptidomic-biological-ageing-clock-predicts-all.md)
- [Urinary collagen type I (COL1) peptides as a shared biomarker signature for fibrosis in chronic di](https://medichelpline.com/clinical-feed/medrxiv-7-urinary-collagen-type-i-degradation-products-as-common-fibrosis-biomarkers-in.md)
- [Long-term cardiovascular risk after assisted reproductive technology and infertility: nationwide c](https://medichelpline.com/clinical-feed/plos-medicine-0-long-term-risk-of-cardiovascular-disease-after-assisted-reproductive-technology.md)
- [Infection Does Not Impair Decongestion or Short-Term Kidney Outcomes in Cardiorenal Syndrome Type 1](https://medichelpline.com/clinical-feed/plos-one-11-impact-of-infection-on-decongestion-and-kidney-outcomes-in-patients-with.md)

## Navigation
- [← Back to Pharmacology Feed](https://medichelpline.com/clinical-feed/pharmacology.md)
- [← All Clinical Specialties](https://medichelpline.com/clinical-feed.md)
## Medical & Regulatory Disclaimer

> [!CAUTION]
> MedicHelpline content is structured for research, educational, and professional discovery purposes. It does not constitute individual medical advice, clinical diagnosis, or treatment recommendations.
> Always verify dosing, contraindications, and regulatory alerts against official product labeling and primary regulatory sources before clinical decision-making.