Safety and Efficacy of Iron Chelators in Patients With Chronic Kidney Disease: A Systematic Review and Meta-Analysis

Background: Iron overload in chronic kidney disease contributes to oxidative injury. The role of iron chelators, standard in transfusion-related overload, remains unclear in chronic kidney disease. Aim: To evaluate the efficacy and safety of iron chelators in adults with chronic kidney disease. Methods: A systematic review and meta-analysis followed PRISMA 2020 guidelines. Databases were searched for randomized controlled trials and observational studies reporting on iron indices, hematological parameters, and adverse events. Results: Eleven studies (206 patients) were included. Iron chelation significantly reduced serum ferritin (weighted mean difference [WMD]: −1.48 μg/L; 95% CI: −2.09, −0.87), transferrin (WMD: −10.6 mg/dL; 95% CI: −15.6, −5.61), and serum iron (WMD: −24.2 μg/dL; 95% CI: −42.5, −5.9). Hemoglobin increased (WMD: 1.07 g/dL; 95% CI: 0.20, 1.94). Glucose levels decreased, but lipid parameters were unaffected. Evidence was limited by high heterogeneity and potential bias. Gastrointestinal adverse events were common; serious events were rare. Conclusion: Iron chelation effectively reduces iron stores and may improve anemia in chronic kidney disease patients. However, the evidence is limited by small sample sizes and heterogeneity. High-quality randomized controlled trials are needed to establish clinical utility and safety before routine use. © 2026 The Author(s). Hemodialysis International published by Wiley Periodicals LLC on behalf of International Society for Hemodialysis.