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 .
The importance of iron in long-term survival of maintenance hemodialysis patients treated with epoetin-alfa and intravenous iron: analysis of 9.5 years of prospectively collected data
Background In patients treated by maintenance hemodialysis the relationship to survival of hemoglobin level and administered epoetin-alfa and intravenous iron is controversial . The study aim was to determine effects on patient survival of administered epoetin-alfa and intravenous iron , and of hemoglobin and variables related to iron status . Methods The patients were 1774 treated by maintenance hemodialysis in 3 dialysis units in New York , NY from January 1998 to June , 2007 . A patient-centered , coded , electronic patient record used in patient care enabled retrospective analysis of data collected prospect ively . For survival analysis , patients were censored when transplanted , transferred to hemodialysis at home or elsewhere , peritoneal dialysis . Univariate Kaplan-Meier analysis was followed by multivariate analysis with Cox 's regression , using as variables age , race , gender , major co-morbid conditions , epoetin-alfa and intravenous iron administered , and 15 laboratory tests . Results Median age was 59 years , epoetin-alfa ( interquartile range ) 18,162 ( 12,099 , 27,741 ) units/week , intravenous iron 301 ( 202 , 455 ) mg/month , survival 789 ( 354 , 1489 ) days . Median hemoglobin was 116 ( 110 , 120)g/L , transferrin saturation 29.7 ( 24.9 , 35.1)% , serum ferritin 526 ( 247 , 833 ) μg/L , serum albumin 39.0 ( 36.3 , 41.5 ) g/L. Survival was better the higher the hemoglobin , best with > 120 g/L. Epoetin-alfa  effect on survival was weak but had statistically significant interaction with intravenous iron . For intravenous iron , survival was best with 1–202 mg/month , slightly worse with 202–455 mg/month ; it was worst with no intravenous iron , only slightly better with > 455 mg/month . Survival was worst with transferrin saturation ≤ 16 % , serum ferritin ≤ 100 μg/L , best with transferrin saturation > 25 % , serum ferritin > 600 μg/L The effects of each of hemoglobin , intravenous iron , transferrin saturation , and serum ferritin on survival were independently significant and not mediated by other predictors in the model . Conclusion Long term survival of maintenance hemodialysis patients was favorably affected by a relatively high hemoglobin level , by moderate intravenous iron administration , and by indicators of iron sufficiency . It was unfavorably influenced by a low hemoglobin level , and by indicators of iron deficiency
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 .