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 .
Evaluating the effectiveness of IV iron dosing for anemia management in common clinical practice: results from the Dialysis Outcomes and Practice Patterns Study (DOPPS)
Background Anemia management protocol s in hemodialysis ( HD ) units differ conspicuously regarding optimal intravenous ( IV ) iron dosing ; consequently , patients receive markedly different cumulative exposures to IV iron and erythropoiesis-stimulating agents ( ESAs ) . Complementary to IV iron safety studies , our goal was to gain insight into optimal IV iron dosing by estimating the effects of IV iron doses on Hgb , TSAT , ferritin , and ESA dose in common clinical practice . Methods 9,471 HD patients ( 11 countries , 2009 - 2011 ) in the DOPPS , a prospect i ve cohort study , were analyzed . Associations of IV iron dose ( 3-month average , categorized as 0 , < 300 , ≥300 mg/month ) with 3-month change in Hgb , TSAT , ferritin , and ESA dose were evaluated using adjusted GEE models . Results Relative change : Monotonically positive associations between IV iron dose and Hgb , TSAT , and ferritin change , and inverse associations with ESA dose change , were observed across multiple strata of prior Hgb , TSAT , and ferritin levels . Absolute change : TSAT , ferritin , and ESA dose changes were nearest zero with IV iron < 300 mg/month , rather than 0 mg/month or ≥300 mg/month by maintenance or replacement dosing . Findings were robust to numerous sensitivity analyses . Conclusions Though residual confounding can not be ruled out in this observational study , findings suggest that IV iron dosing < 300 mg/month , as commonly seen with maintenance dosing of 100 - 200 mg/month , may be a more effective approach to support Hgb than the higher IV iron doses ( 300 - 400 mg/month ) often given in many European and North American hemodialysis clinics . Alongside studies supporting the safety of IV iron in 100 - 200 mg/month dose range , these findings help guide the rational dosing of IV iron in anemia management protocol s for everyday hemodialysis practice
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 .