José Antonio García-Erce

Background: Most studies evaluate perioperative hemoglobin at a single time point despite substantial changes across the perioperative period. We examined whether perioperative hemoglobin trajectory and perioperative hemoglobin decrease were associated with postoperative outcomes after major abdominal surgery. Methods: We performed a secondary analysis of the international POSTVenTT cohort, a prospective multicentre observational study of adults undergoing major abdominal surgery. Hemoglobin trajectory was defined according to anemia status preoperatively and at hospital discharge. Perioperative hemoglobin decrease was defined as the difference between preoperative and discharge hemoglobin concentration. Mixed‐effects logistic regression models adjusted for predefined clinical covariates and center clustering were used to evaluate associations with postoperative complications, postoperative transfusion, and 30‐day readmission. Results: Among 5302 patients, 3735 had both preoperative and discharge hemoglobin measurements and were included in trajectory analyses. Compared with patients without perioperative anemia, persistent anemia was associated with the higher odds of postoperative complications, postoperative transfusion, and 30‐day readmission, whereas new postoperative anemia showed similar but smaller associations. Greater perioperative hemoglobin decrease was associated with higher odds of postoperative complications. For each 10 g/L decrease, the odds of any postoperative complication increased by 35% (OR 1.35, 95% CI 1.26–1.45) and major complication by 49% (OR 1.49, 1.35–1.64). Associations persisted after accounting for transfusion exposure and baseline hemoglobin. Conclusions: Perioperative hemoglobin trajectory and perioperative hemoglobin decrease were associated with postoperative complications and 30‐day readmission after major abdominal surgery. Greater hemoglobin decrease remained associated with adverse outcomes after accounting for transfusion exposure and baseline hemoglobin. Trial Registration: The POSTVenTT study was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12621001517864; 8 November 2021). The trial protocol was approved by the South Metropolitan Health Service (Western Australia) Health Research Ethics Committee (EC00265), the Western Australia Research Governance System (RCG 4477), with local ethics and governance confirmed at each site before patient recruitment

Iron deficiency (ID) is the most prevalent nutritional disorder worldwide, affecting diverse populations including children, women of reproductive age, older adults and patients with chronic conditions. Oral iron supplementation remains the cornerstone of treatment, together with management of the underlying causes. However, conventional ferrous and ferric salts are often associated with gastrointestinal side effects, poor adherence and limited efficacy, especially in inflammatory settings due to hepcidin-mediated absorption blockade. This review summarizes iron absorption physiology, limitations of traditional oral therapies, and the potential benefits of iron protein succinylate (IPS), a ferric complex bound to succinylated casein. IPS provides pH-dependent release and contains succinic acid, which may enhance absorption while reducing gastrointestinal adverse events. Clinical studies indicate that IPS achieves hematologic outcomes comparable or superior to standard oral salts, fewer gastrointestinal effects and better tolerability. These properties make IPS suitable for patients who do not tolerate or respond adequately to conventional therapy. Special attention is given to chronic inflammation, pregnancy, cancer, or gastrointestinal disorders, where oral iron often fails due to impaired absorption or poorer tolerance. Practical recommendations are included to optimize supplementation through dosing strategies and tailored approaches. Overall, IPS offers an effective, better-tolerated alternative to conventional oral iron therapy.

Background: Anemia is a common complication in chronic kidney disease (CKD), especially in hemodialysis patients, causing fatigue and reduced quality of life. Standard treatments involve iron and erythropoietin (EPO). Ascorbic acid (vitamin C) supports iron metabolism by converting ferric to ferrous iron and enhancing absorption and mobilization. This systematic review and meta-analysis evaluated the effectiveness of ascorbic acid in improving hematologic and iron parameters in adult anemic patients undergoing maintenance hemodialysis. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a comprehensive search was performed in PubMed, EMBASE, Cochrane, Scopus, Web of Science, CINAHL and Google Scholar through May 2025. Only randomized controlled trials and crossover studies assessing ascorbic acid in adult anemic hemodialysis patients were included. The protocol was registered in the International Prospective Register of Systematic Review (PROSPERO) (CRD420251056337). Primary outcomes were hemoglobin (Hb), ferritin, serum iron, transferrin saturation (TSAT) and total iron-binding capacity (TIBC). Meta-analyses used DerSimonian-Laird random-effects models. Results: Of 479 screened articles, 14 studies were included. Ascorbic acid supplementation was associated with a modest but significant increase in Hb [mean difference (MD) 0.94 g/dL; 95% confidence interval (CI) 0.57 to 1.31; P < .01; I² = 87.2%] and TSAT (MD 6.86%; 95% CI 1.93 to 11.78; P < .01; I² = 96.7%). Ferritin levels showed a slight but significant reduction (MD −65.00 ng/mL; 95% CI −117.20 to −12.80; P = .01; I² = 57.2%), along with a decrease in TIBC (MD −22.54 µg/dL; 95% CI −42.37 to −2.72; P = .03; I² = 76.1%). EPO requirements expressed as units/kg/week were significantly reduced (MD −21.29; 95% CI −27.73 to −14.84; P < .01; I² = 0.0%). No significant changes were observed in serum iron levels or EPO dosage expressed as IU/week. Conclusion: Ascorbic acid supplementation may confer modest hematologic benefits in hemodialysis patients with improvements in Hb, TSAT and iron utilization, and a small reduction in weight-adjusted erythropoiesis-stimulating agent dose. However, the certainty of evidence is low, and long-term safety and patient-centered outcomes remain unestablished.