Pharmacokinetic characteristics of iron preparations in patients with anemia of chronic disease. A cohort study
Pozdnyakov A.V., Astapovsky A.A., Drozdov V.N., Eremenko N.N., Shikh E.V.
Background: Anemia of chronic disease is one of the most common types of anemia worldwide and the most common form in people with chronic diseases. The development of this anemia aggravates the patient’s condition, leads to progression of the underlying disease, and worsens the prognosis; therefore, patients require timely treatment.
Objective: Comparison of the pharmacokinetics of iron supplements in patients with iron deficiency associated with anemia of chronic disease versus patients with isolated iron deficiency anemia.
Materials and methods: A prospective, open-label, cohort, single-center study was conducted in patients with a laboratory-confirmed diagnosis of anemia. One group included patients with iron deficiency anemia, and the other included patients with iron deficiency associated with anemia of chronic disease and elevated hepcidin levels. Blood samples were collected over two days to assess the pharmacokinetics of iron supplements. On the first day, serum endogenous iron concentrations were measured, and on the second day, values were assessed after administration of tablets containing 200 mg of ferrous sulfate and 120 mg of ascorbic acid.
Results: The study included 30 female patients (15 patients in each group) aged 41 to 67 years. There were no statistically significant differences in age or hemoglobin levels between the study groups. Ferritin and hepcidin levels were statistically significantly higher in the group of patients with iron deficiency anemia of chronic disease.
The mean AUC (and standard deviation) after taking the iron supplement, calculated with adjustment for background endogenous iron levels based on pre-treatment data, was 39.80 (19.75) μmol*h/L in the group of patients with iron deficiency anemia of chronic disease and was statistically significantly lower than the AUC value in the group of patients with iron deficiency anemia (p<0.05), which was 150.19 (71.58) μmol*h/L. The relative bioavailability of iron in the group of patients with iron deficiency in anemia of chronic disease compared to the group of patients with iron deficiency anemia was 26.5%. The mean value of the maximum concentration Cmax after taking the iron preparation in the group of patients with iron deficiency in anemia of chronic disease was also statistically significantly lower than the value in the group of patients with iron deficiency anemia (5.4 [3.5] μmol/L versus 25.2 [7.4] μmol/L, respectively, p<0.05), and Cmax was achieved in the group of patients with iron deficiency in anemia of chronic disease statistically significantly later (after 6.9 [1.2] hours versus 3.2 [0.9] hours, p<0.05).
Conclusion: In patients with iron deficiency and elevated hepcidin levels in anemia of chronic disease, iron bioavailability after taking oral preparations containing it is significantly reduced compared to patients with isolated iron deficiency anemia. For patients with anemia of chronic disease, other treatment strategies should be considered.
For citations: Pozdnyakov A.V., Astapovsky A.A., Drozdov V.N., Eremenko N.N., Shikh E.V. Pharmacokinetic characteristics of iron preparations in patients with anemia of chronic disease. A cohort study. Pharmateca. 2026;33(1):180-186. (In Russ.). DOI: https://dx.doi.org/10.18565/pharmateca.2026.1.180-186
Authors’ contribution: A.V. Pozdnyakov — study concept and design, data collection and statistical analysis, writing the manuscript, preparation of figures and tables. A.A. Astapovsky — critical literature review, participation in data analysis. V.N. Drozdov — study supervision, research design, editing the manuscript. N.N. Eremenko — participation in technical editing and formatting the bibliography. E.V. Shikh — scientific consulting, approval of the final version of the article, responsibility for the integrity of the study.
Conflicts of interest: The authors confirm that they have no conflicts of interest to declare.
Funding: The study was conducted without any sponsorship.
Ethical Approval: This study was approved by the local ethics committee of the Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), protocol No. 01-21 dated January 23, 2025.
Patient Consent for Publication: All patients provided informed consent for the publication of their data.
Authors’ Data Sharing Statement: The data supporting the findings of this study are available upon request from the corresponding author after approval from the principal investigator.
Keywords
anemia of chronic disease
autoimmune diseases
iron
iron deficiency
hepcidin
About the Authors
Anatoly V. Pozdnyakov, Clinical Pharmacologist, City Polyclinic No. 115 of the Moscow Healthcare Department, Moscow, Russia;dr.a.pozdnyakov@gmail.com, ORCID: https://orcid.org/0009-0003-8553-6727 (corresponding author)
Aleksandr A. Astapovsky, I.M. Sechenov First Moscow State Medical University (Sechenov University); War Veterans’ Hospital No. 3 of the Moscow Healthcare Department, Moscow, Russia; ORCID: https://orcid.org/0000-0002-7430-3341
Vladimir N. Drozdov, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; ORCID: https://orcid.org/0000-0002-0535-2916
Natalia N. Eremenko, I.M. Sechenov First Moscow State Medical University (Sechenov University); Scientific Center for Expertise of Medicinal Products, Moscow, Russia; ORCID: https://orcid.org/0000-0003-2385-7114
Evgeniya V. Shikh, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; ORCID: https://orcid.org/0000-0001-6589-7654
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