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 .
Ferric Citrate Reduces Intravenous Iron and Erythropoiesis-Stimulating Agent Use in ESRD.
Ferric citrate ( FC ) is a phosphate binder with shown efficacy and additional effects on iron stores and use of intravenous ( iv ) iron and erythropoiesis-stimulating agents ( ESAs ) . We provide detailed analyses of changes in iron/hematologic parameters and  iv iron/ESA  use at time points throughout the active control period of a phase 3 international r and omized clinical trial . In all , 441 subjects were r and omized ( 292 to FC and 149 to sevelamer carbonate and /or calcium acetate [ active control ( AC ) ] ) and followed for 52 weeks . Subjects on FC had increased ferritin and transferrin saturation ( TSAT ) levels compared with subjects on AC by week 12 ( change in ferritin , 114.1±29.35 ng/ml ; P<0.001 ; change in TSAT , 8.62%±1.57 % ; P<0.001 ) . Change in TSAT plateaued at this point , whereas change in ferritin increased through week 24 , remaining relatively stable thereafter . Subjects on FC needed less iv iron compared with subjects on AC over 52 weeks ( median [ interquartile range ] dose=12.9 [ 1.0 - 28.9 ] versus 26.8 [ 13.4 - 47.6 ] mg/wk ; P<0.001 ) , and the percentage of subjects not requiring iv iron was higher with FC ( P<0.001 ) . Cumulative ESA over 52 weeks was lower with FC than AC ( median [ interquartile range ] dose=5303 [ 2023 - 9695 ] versus 6954 [ 2664 - 12,375 ] units/wk ; P=0.04 ) . Overall , 90.3 % of subjects on FC and 89.3 % of subjects on AC experienced adverse events . In conclusion , treatment with FC as a phosphate binder results in increased iron parameters apparent after 12 weeks and reduces iv iron and ESA use while maintaining hemoglobin over 52 weeks , with a safety profile similar to that of available binders
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 .