Is oral iron always the best option?

Grau Amorós, J.

doi:10.1016/j.rceng.2019.11.002

array:24 ["pii" => "S2254887420300023" "issn" => "22548874" "doi" => "10.1016/j.rceng.2019.11.002" "estado" => "S300" "fechaPublicacion" => "2020-01-01" "aid" => "1767" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)" "copyrightAnyo" => "2019" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "edi" "cita" => "Rev Clin Esp. 2020;220:27-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0014256519302954" "issn" => "00142565" "doi" => "10.1016/j.rce.2019.11.002" "estado" => "S300" "fechaPublicacion" => "2020-01-01" "aid" => "1767" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "edi" "cita" => "Rev Clin Esp. 2020;220:27-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 59 "formatos" => array:2 [ "HTML" => 27 "PDF" => 32 ] ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "EDITORIAL" "titulo" => "¿Es siempre el tratamiento con hierro oral la mejor opción terapéutica?" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "27" "paginaFinal" => "28" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Is oral Iron therapy always the best option?" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Grau Amorós" "autores" => array:1 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Grau Amorós" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2254887420300023" "doi" => "10.1016/j.rceng.2019.11.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887420300023?idApp=WRCEE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256519302954?idApp=WRCEE" "url" => "/00142565/0000022000000001/v1_202001221235/S0014256519302954/v1_202001221235/es/main.assets" ] ] "itemSiguiente" => array:18 [ "pii" => "S2254887420300011" "issn" => "22548874" "doi" => "10.1016/j.rceng.2019.11.001" "estado" => "S300" "fechaPublicacion" => "2020-01-01" "aid" => "1777" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "edi" "cita" => "Rev Clin Esp. 2020;220:29-30" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:9 [ "idiomaDefecto" => true "cabecera" => "EDITORIAL" "titulo" => "Improving the care of people with chronic conditions in Spain. Common Position Statement of the Spanish Society of Internal Medicine and the Spanish Society of Family and Community Medicine" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "29" "paginaFinal" => "30" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Mejoras en la atención a personas con enfermedades crónicas en España. Declaración de posición común de la Sociedad Española de Medicina Interna y la Sociedad Española de Medicina Familiar y Comunitaria" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0014256519303054" "doi" => "10.1016/j.rce.2019.11.010" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256519303054?idApp=WRCEE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887420300011?idApp=WRCEE" "url" => "/22548874/0000022000000001/v1_202002130124/S2254887420300011/v1_202002130124/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S2254887419302589" "issn" => "22548874" "doi" => "10.1016/j.rceng.2019.09.011" "estado" => "S300" "fechaPublicacion" => "2020-01-01" "aid" => "1728" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "edi" "cita" => "Rev Clin Esp. 2020;220:24-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "Editorial" "titulo" => "Metformin and sodium-glucose cotransporter inhibitors as therapy for type 1 diabetes mellitus: Handle with care" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "24" "paginaFinal" => "26" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Metformina e inhibidores del cotransportador sodio-glucosa en el tratamiento de la diabetes mellitus tipo 1: manéjese con cuidado" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Ena, R. Gómez-Huelgas" "autores" => array:2 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Ena" ] 1 => array:2 [ "nombre" => "R." "apellidos" => "Gómez-Huelgas" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0014256519302279" "doi" => "10.1016/j.rce.2019.09.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256519302279?idApp=WRCEE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887419302589?idApp=WRCEE" "url" => "/22548874/0000022000000001/v1_202002130124/S2254887419302589/v1_202002130124/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "EDITORIAL" "titulo" => "Is oral iron always the best option?" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "27" "paginaFinal" => "28" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "J. Grau Amorós" "autores" => array:1 [ 0 => array:3 [ "nombre" => "J." "apellidos" => "Grau Amorós" "email" => array:1 [ 0 => "11426jga@comb.cat" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Grupo de Trabajo de Insuficiencia Cardiaca y Fibrilación auricular, Sociedad Española de Medicina Interna" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Es el hierro oral siempre la mejor opción?" ] ] "textoCompleto" => "The administration of iron for therapeutic goals traces back several centuries; however, the likelihood of severe hypersensitivity reactions has limited the use of intravenous iron until recent years. The development of new formulations without risk has resulted in a marked increase in scientific publications in the past 20 years. Most authors prudently recommend starting with oral treatment, not only because of its lower cost but also for being the most physiological pathway and due to the risk of toxicity in repeated intravenous treatments. A couple of articles published in the Revista Clínica Española support this approach,<a class="elsevierStyleCrossRefs" href="#bib0075">1,2</a> the first of which revealed a number of gaps in our current understanding of iron metabolism in heart failure, especially in recognizing and treating tissue iron deficiency. The study also warns of the potential toxicity risk of using massive doses of intravenous iron, defending the use of oral iron as the first option, despite the results of the IRONOUT-HF study that failed to improve the maximal tissue oxygen uptake or increase the distance travelled by patients in the 6-min walking test. In the other article, the authors revealed the consensus of the Spanish Erythropathology Group of the Spanish Society of Hematology and Hemotherapy on managing iron deficiency in various conditions. This meritorious effort in synthesizing the consensus has resulted in a document that can be quickly consulted to determine the best approach for our daily clinical practice. The authors also recommended the use of orally administered iron, reserving intravenous administration for therapeutic failure and the inability to digestively absorb iron.However, is this reserving of intravenous iron solidly grounded? Is the use of oral iron more cost-effective than intravenous administration in clinical practice? Do the savings resulting from the lower cost of oral medication justify the delay in feeling the benefits of iron? Is there sufficient evidence to support the fear of toxicity in intermittent intravenous iron administration?The frequent gastrointestinal intolerance to oral iron is well known and results in therapeutic noncompliance and frequent treatment abandonment. There are administration strategies that decrease the intolerance, but if they do not improve tolerance and the iron deposits are not replenished then the clinician has to resort to intravenous iron. With this, the necessary treatment has been delayed, in the best of cases, by a month. This situation entails prolonging the work leave for young adults and, for older individuals, increasing the time during which there is a risk of frailty. This older population is increasingly numerous in our consultations and has a high incidence of anemia and iron deficiency, without a specific etiological diagnosis in up to 30% of cases.<a class="elsevierStyleCrossRef" href="#bib0085">3</a> This group often has chronic ailments, where iron metabolism is complicated, with several etiological mechanisms in the onset of anemia, with or without iron deficiency.<a class="elsevierStyleCrossRefs" href="#bib0075">1,2</a> In this scenario, it is easy to understand why oral iron in the IRONOUT-HF study did not achieve the objectives achieved with intravenous iron in the trial FAIR-HF,<a class="elsevierStyleCrossRefs" href="#bib0090">4,5</a> calling into question the efficacy of oral iron in correcting the needs of the cardiomyocyte. This finding also revealed the need for improving the study of iron deficiencies in the clinic. The measurement of soluble transferrin receptors should be incorporated in all clinical analysis laboratories, and a standardized test to measure hepcidin levels is an increasingly obvious necessity.Another discussion point is intravenous iron toxicity after the emergence of formulations with complex carbohydrate cores that more strongly bind to elemental iron, limiting the release (at subclinical levels) of free iron. A meta-analysis of published trials on the adverse effects of these formulations has shown no greater risk of severe adverse events compared with controls, and, as expected, the rate of gastrointestinal reactions was significantly lower.<a class="elsevierStyleCrossRef" href="#bib0100">6</a> This result does not preclude being careful and vigilant as to the adverse effects with very low incidence rates that are usually missed in the limited follow-ups of clinical trials.Given iron's ability to promote oxidative stress in endothelial cells, there is the worrying possibility that the use of iron increases the risk of cardiovascular events. Once again, a meta-analysis of trials with high cardiovascular risk populations, such as patients undergoing dialysis, found no evidence to support this hypothesis.<a class="elsevierStyleCrossRef" href="#bib0105">7</a>Another of the limitations classically put forward for restricting the use of intravenous iron therapy is the likelihood of increasing the incidence of infections, given that free iron is an essential nutrient, not only for humans but also for most of its microbial pathogens.<a class="elsevierStyleCrossRef" href="#bib0110">8</a> However, none of the meta-analyses conducted on various diseases has confirmed this possibility. Furthermore, a recent trial examining the safety of high doses of intravenous iron in patients undergoing hemodialysis also found no differences in hospitalizations for infection between the two treatment regimens.<a class="elsevierStyleCrossRef" href="#bib0115">9</a> Moreover, in patients with inflammatory bowel disease, intravenous iron therapy produced no changes in the gut microbiome when compared with oral iron,<a class="elsevierStyleCrossRef" href="#bib0120">10</a> an emerging factor in many aspects, including cardiovascular risk.Lastly, we have cost-benefit studies in favor of the use of intravenous iron in inflammatory bowel disease, chronic renal failure and chronic heart failure accompanied by anemia or iron deficiency without anemia. The savings in the total cost of medical care more than compensates for the higher cost of the drug.<a class="elsevierStyleCrossRefs" href="#bib0125">11–14</a>In conclusion, the simplicity and convenience of oral iron administration is not the only factor to consider; in the practice of medicine, generalizing is risky. Scientific guidelines and recommendations are necessary and highly useful, but the medical act is individualized. All adjuvant factors need to be considered and, whenever possible, patients should be empowered in the therapeutic decisions." "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Grau Amorós J. ¿Es el hierro oral siempre la mejor opción?. Rev Clin Esp. 2019. https://doi.org/10.1016/j.rce.2019.11.002" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:14 [ 0 => array:3 [ "identificador" => "bib0075" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "López MAN. Hierro e insuficiencia cardiaca. DOI:10.1016/j.rce.2019.06.011." ] ] ] 1 => array:3 [ "identificador" => "bib0080" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "García Erce JA, Altés A, López Rubio M, Remacha AF. Manejo del déficit de hierro en distintas situaciones clínicas y papel del hierro intravenoso: recomendaciones del grupo español de eritropatología de la SEHH." ] ] ] 2 => array:3 [ "identificador" => "bib0085" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Unexplained anemia predominates despite an intensive evaluation in a racially diverse cohort of older adults from a referral anemia clinic" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A.S. Artz" 1 => "M.J. Thirman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/gerona/glr090" "Revista" => array:6 [ "tituloSerie" => "J Gerontol A Biol Sci Med Sci." "fecha" => "2011" "volumen" => "66" "paginaInicial" => "925" "paginaFinal" => "932" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21659341" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0090" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "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" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G.D. Lewis" 1 => "R. Malhotra" 2 => "A.F. Hernandez" 3 => "S.E. McNulty" 4 => "A. Smith" 5 => "G.M. Felker" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jama.2017.5427" "Revista" => array:6 [ "tituloSerie" => "JAMA." "fecha" => "2017" "volumen" => "317" "paginaInicial" => "1958" "paginaFinal" => "1966" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28510680" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0095" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ferric carboxymaltose in patients with heart failure and iron deficiency" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.D. Anker" 1 => "J. Comin Colet" 2 => "G. Filippatos" 3 => "R. Willenheimer" 4 => "K. Dickstein" 5 => "H. Drexler" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa0908355" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med." "fecha" => "2009" "volumen" => "361" "paginaInicial" => "2436" "paginaFinal" => "2448" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19920054" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0100" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The safety of intravenous iron preparations: Systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "T. Avni" 1 => "A. Bieber" 2 => "A. Grossman" 3 => "H. Green" 4 => "L. Leibovici" 5 => "A. Gafter-Gvili" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.mayocp.2014.10.007" "Revista" => array:6 [ "tituloSerie" => "Mayo Clin Proc." "fecha" => "2015" "volumen" => "90" "paginaInicial" => "12" "paginaFinal" => "23" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25572192" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0105" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Safety of Intravenous iron in dialysis: A systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "I. Hougen" 1 => "D. Collister" 2 => "M. Bourrier" 3 => "T. Ferguson" 4 => "L. Hochheim" 5 => "P. Komenda" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2215/CJN.05390517" "Revista" => array:6 [ "tituloSerie" => "Clin J Am Soc Nephrol." "fecha" => "2018" "volumen" => "13" "paginaInicial" => "457" "paginaFinal" => "467" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29463597" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0110" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Iron in infection and immunity" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.E. Cassat" 1 => "E.P. Skaar" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.chom.2013.04.010" "Revista" => array:6 [ "tituloSerie" => "Cell Host Microbe." "fecha" => "2013" "volumen" => "13" "paginaInicial" => "509" "paginaFinal" => "519" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23684303" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0115" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intravenous Iron in Patients Undergoing Maintenance Hemodialysis" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "PIVOTAL Investigators and Committees" "etal" => true "autores" => array:6 [ 0 => "I.C. Macdougall" 1 => "C. White" 2 => "S.D. Anker" 3 => "S. Bhandari" 4 => "K. Farrington" 5 => "P.A. Kalra" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa1810742" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med." "fecha" => "2019" "volumen" => "380" "paginaInicial" => "447" "paginaFinal" => "458" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30365356" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0120" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Oral versus intravenous iron replacement therapy distinctly alters the gut microbiota and metabolome in patients with IBD" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T. Lee" 1 => "T. Clavel" 2 => "K. Smirnov" 3 => "A. Schmidt" 4 => "I. Lagkouvardos" 5 => "A. Walker" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/gutjnl-2015-309940" "Revista" => array:6 [ "tituloSerie" => "Gut." "fecha" => "2017" "volumen" => "66" "paginaInicial" => "863" "paginaFinal" => "871" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26848182" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0125" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Oral versus intravenous iron therapy in patients with inflammatory bowel disease and iron deficiency with and without anemia in Germany —a real-world evidence analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Stein" 1 => "J.S. Haas" 2 => "S.H. Ong" 3 => "K. Borchert" 4 => "T. Hardt" 5 => "E. Lechat" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2147/CEOR.S150900" "Revista" => array:6 [ "tituloSerie" => "Clinicoecon Outcomes Res." "fecha" => "2018" "volumen" => "10" "paginaInicial" => "93" "paginaFinal" => "103" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29440920" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0130" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An economic evaluation of intravenous versus oral iron supplementation in people on haemodialysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "G. Wong" 1 => "K. Howard" 2 => "E. Hodson" 3 => "M. Irving" 4 => "J.C. Craig" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/ndt/gfs487" "Revista" => array:6 [ "tituloSerie" => "Nephrol Dial Transplant." "fecha" => "2013" "volumen" => "28" "paginaInicial" => "413" "paginaFinal" => "420" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23182811" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0135" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evaluación económica de la utilización de hierro carboximaltosa en pacientes con deficiencia de hierro e insuficiencia cardiaca crónica en España" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Comín-Colet" 1 => "D. Rubio-Rodríguez" 2 => "C. Rubio-Terrés" 3 => "C. Enjuanes-Grau" 4 => "F.S. Gutzwiller" 5 => "S.D. Anker" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rec.2014.10.010" "Revista" => array:6 [ "tituloSerie" => "Rev Esp Cardiol." "fecha" => "2015" "volumen" => "68" "paginaInicial" => "846" "paginaFinal" => "851" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25649970" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0140" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Budget Impact of intravenous iron therapy with ferric carboxymaltose in patients with chronic heart failure and iron deficiency in Germany" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "U. Theidel" 1 => "S. Väätäinen" 2 => "J. Martikainen" 3 => "E. Soini" 4 => "T. Hardt" 5 => "W. Doehner" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ehf2.12179" "Revista" => array:6 [ "tituloSerie" => "ESC Heart Fail" "fecha" => "2017" "volumen" => "4" "paginaInicial" => "274" "paginaFinal" => "281" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28772041" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/22548874/0000022000000001/v1_202002130124/S2254887420300023/v1_202002130124/en/main.assets" "Apartado" => array:4 [ "identificador" => "72714" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Editorials" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/22548874/0000022000000001/v1_202002130124/S2254887420300023/v1_202002130124/en/main.pdf?idApp=WRCEE&text.app=https://revclinesp.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887420300023?idApp=WRCEE"]

Revista Clínica Española (English Edition)

ISSN: 2254-8874

Revista Clínica Española published its first issue in 1940 and is the body of expression of the Spanish Society of Internal Medicine (SEMI).
The journal fully endorses the goals of updating knowledge and facilitating the acquisition of key developments in internal medicine applied to clinical practice. Revista Clínica Española is subject to a thorough double blind review of the received articles written in Spanish or English. Ten issues are published each year, including mostly originals, reviews and consensus documents.

Indexed in:

Current Contents / Clinical Medicine , JCR / SCI-Expanded, Index Medicus / Medline y Excerpta Medica / EMBASE

Subscribe:

Impact factor

The Impact Factor measures the average number of citations received in a particular year by papers published in the journal during the two preceding years.

© Clarivate Analytics, Journal Citation Reports 2022

Impact factor 2023

2.3

Citescore

CiteScore measures average citations received per document published.

Citescore 2023

0.7

SJR

SRJ is a prestige metric based on the idea that not all citations are the same. SJR uses a similar algorithm as the Google page rank; it provides a quantitative and qualitative measure of the journal's impact.

SJR 2023

0.162

SNIP

SNIP measures contextual citation impact by wighting citations based on the total number of citations in a subject field.

SNIP 2023

0.211

View more metrics

Open Access Option

Journal Information

Previous article | Next article

Vol. 220. Issue 1.

Pages 27-28 (January - February 2020)

Lee este artículo en Español

Export reference

Download PDF

Article

These are the options to access the full texts of the publication Revista Clínica Española (English Edition)

Member of the society

Subscriber

Contact

Member

Si es usted socio de FESEMI siga los siguientes pasos:

Diríjase desde aquí a la web de la >>>FESEMI<<< e inicie sesión mediante el formulario que se encuentra en la barra superior, pulsando sobre el candado.