The safety of iron in dialysis

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The safety of iron in dialysis

How safe is intravenous iron for patients on hemodialysis (HD)? Surprisingly, the data on this subject offer a picture that is far from clear.

Currently, it is thought that higher dose intravenous iron increases the risk of infections, cardiovascular events, hospitalizations and mortality. Canadian researchers aimed to shine more light on this important topic by investigating the safety of iron administered in various ways in adult HD patients: higher-dose versus lower-dose intravenous iron, oral iron, or no iron supplementation (Hougen I et al, Safety of Intravenous Iron in Dialysis; Clin J Am Soc Nephrol. 2018 Mar 7;13(3):457-467).

After searching various data bases (Medline, EMBASE, Cochrane library, and CINAHL), the authors initially found 2,231 eligible studies. Of these, 7 as randomized, controlled trials (RCTs) and 15 as observational studies met inclusion criteria.

The main results:

The RCTs (n=743 to 970) with a follow-up ranging from 35 days to 26 months showed no association between higher-dose intravenous iron (>400 mg/month for most studies) and mortality (pooled relative risk, 0.93) or infection (1.02).

The observational studies (n=135,000 to 241,000) with a follow-up ranging from 3 to 24 months also found no association between higher-dose intravenous iron (>200 mg/month for most studies) and mortality (1.09) or infection (1.13).

In addition, the observational studies saw no association between higher-dose intravenous iron and cardiovascular events (1.18) or hospitalizations (1.08).

In these studies, higher-dose intravenous iron did not seem to be associated with higher risk of mortality, infection, cardiovascular events, or hospitalizations in adult patients on dialysis. However, the Canadian researchers also point out that the RCTs only included a small number of participants, while the observational studies showed a statistical heterogeneity, both of which factors limit the strength of these findings. 

Link to the study: http://cjasn.asnjournals.org/content/13/3/457.abstract