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 .
Time-dependent associations between iron and mortality in hemodialysis patients.
The independent association between the indices of iron stores or administered intravenous iron , both of which vary over time , and survival in patients who are on maintenance hemodialysis ( MHD ) is not clear . It was hypothesized that the observed associations between moderately high levels of three iron markers ( serum ferritin , iron , and iron saturation ratio ) or administered intravenous iron and all-cause and cardiovascular death is due to the time-varying confounding effect of malnutrition-inflammation-cachexia syndrome ( MICS ) . Time-dependent Cox regression models were examined using prospect ively collected data of the 2-yr ( July 2001 to June 2003 ) historical cohort of 58,058 MHD patients from virtually all DaVita dialysis clinics in the United States . After time-dependent and multivariate adjustment for case mix , administered intravenous iron and erythropoietin doses , and available surrogates of MICS , serum ferritin levels between 200 and 1200 ng/ml ( reference 100 to 199 ng/ml ) , serum iron levels between 60 and 120 microg/ml ( reference 50 to 59 microg/ml ) , and iron saturation ratio between 30 and 50 % ( reference 45 to 50 % ) were associated with the lowest all-cause and cardiovascular death risks . Compared with those who did not receive intravenous iron , administered intravenous iron up to 400 mg/mo was associated with improved survival , whereas doses > 400 mg/mo tended to be associated with higher death rates . The association between serum ferritin levels > 800 ng/ml and mortality in MHD patients seems to be due mostly to the confounding effects of MICS . For ascertaining whether the observed associations between moderate doses of administered intravenous iron and improved survival are causal or due to selection bias by indication , clinical trials are warranted
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 .