Abstract: Objective  To compare the clinical efficacy and safety of intravenous iron isomaltoside and iron sucrose in maintenance hemodialysis (MHD) patients with iron deficiency anemia (IDA).  Methods  A total of 82 MHD patients with IDA treated at the People’s Hospital of Xinjiang Uygur Autonomous Region between March 2022 and January 2025 were retrospectively analyzed. Patients were divided into an iron isomaltoside group (n=54) and an iron sucrose group (n=28). Changes in hemoglobin (Hb), serum ferritin (SF), transferrin saturation (TSAT), and adverse events were compared between the groups during a 6-month follow-up period. Results  The mean age of the patients was 54 years (range 19～83), with 56.1% males. At 1 month after treatment, the increase in Hb was significantly greater in the iron isomaltoside group than in the iron sucrose group (18 g/L vs. 11 g/L; P=0.030, Z=-2.164). The hematological response rate (40.7% vs. 17.9%; P=0.011, χ2=6.413) and target Hb achievement rate (22.2% vs. 0%; P =0.004, χ2=8.472) were also higher in the iron isomaltoside group, and this advantage persisted at 2 months. No significant differences were observed in SF or TSAT between the groups (P＞0.05). One patient in the iron isomaltoside group experienced transient fever, while no adverse events occurred in the iron sucrose group. Conclusion  Compared with iron sucrose, iron isomaltoside provides a faster correction of anemia and a superior short-term hematologic response in MHD patients, with a comparable safety profile. Its single high-dose infusion regimen may also enhance patient compliance and convenience.

Key words: Maintenance hemodialysis, Iron isomaltoside, Iron sucrose, Efficacy, Safety