High-dose parenteral iron does not seem to be associated with higher risk of infection , all-cause mortality , increased hospitalization or increased cardiovascular events on analysis of RCTs .
Observational studies show increased risk for all-cause mortality , infections and hospitalizations that were not statistically significant and were associated with significant heterogeneity
Parental iron is used to optimize hemoglobin and enhance erythropoiesis in end-stage renal disease along with erythropoietin-stimulating agents .
Safety of iron has been debated extensively and there is no definite evidence whether parenteral iron increases the risk of infections and mortality .
We performed this meta- analysis to evaluate the incidence of infectious complications , hospitalizations and mortality with use of parenteral iron .
Intravenous iron exposure and mortality in patients on hemodialysis.
BACKGROUND AND OBJECTIVES Clinical trials assessing effects of larger cumulative iron exposure with outcomes are lacking , and observational studies have been limited by assessment of short-term exposure only and /or failure to assess cause-specific mortality . The associations between short- and long-term iron exposure on all-cause and cause-specific mortality were examined . DESIGN , SETTING , PARTICIPANTS , & MEASUREMENTS The study included 14,078 United States patients on dialysis initiating dialysis between 2003 and 2008 .  Intravenous iron dose accumulations over 1- , 3- , and 6-month rolling windows were related to all-cause , cardiovascular , and infection-related mortality in Cox proportional hazards models that used marginal structural modeling to control for time-dependent confounding . RESULTS Patients in the 1-month model cohort ( n=14,078 ) were followed a median of 19 months , during which there were 27.6 % all-cause deaths , 13.5 % cardiovascular deaths , and 3 % infection-related deaths . A reduced risk of all-cause mortality with receipt of > 150 - 350 ( hazard ratio , 0.78 ; 95 % confidence interval , 0.64 to 0.95 ) or > 350 mg ( hazard ratio , 0.79 ; 95 % confidence interval , 0.62 to 0.99 ) intravenous iron compared with > 0 - 150 mg over 1 month was observed . There was no relation of 1-month intravenous iron dose with cardiovascular or infection-related mortality and no relation of 3- or 6-month cumulative intravenous iron dose with all-cause or cardiovascular mortality . There was a nonstatistically significant increase in infection-related mortality with receipt of > 1050 mg intravenous iron in 3 months ( hazard ratio , 1.69 ; 95 % confidence interval , 0.87 to 3.28 ) and > 2100 mg in 6 months ( hazard ratio , 1.59 ; 95 % confidence interval , 0.73 to 3.46 ) . CONCLUSIONS Among patients on incident dialysis , receipt of ≤ 1050 mg intravenous iron in 3 months or 2100 mg in 6 months was not associated with all-cause , cardiovascular , or infection-related mortality . However , nonstatistically significant findings suggested the possibility of infection-related mortality with receipt of > 1050 mg in 3 months or > 2100 mg in 6 months . R and omized clinical trials are needed to assess the safety of exposure to greater cumulative intravenous iron doses
High-dose parenteral iron does not seem to be associated with higher risk of infection , all-cause mortality , increased hospitalization or increased cardiovascular events on analysis of RCTs .
Observational studies show increased risk for all-cause mortality , infections and hospitalizations that were not statistically significant and were associated with significant heterogeneity
Parental iron is used to optimize hemoglobin and enhance erythropoiesis in end-stage renal disease along with erythropoietin-stimulating agents .
Safety of iron has been debated extensively and there is no definite evidence whether parenteral iron increases the risk of infections and mortality .
We performed this meta- analysis to evaluate the incidence of infectious complications , hospitalizations and mortality with use of parenteral iron .