Iron dosing regimens affect dialysis patients' infection risk

June 20, 2013

While intravenous iron is critical for maintaining the health of many dialysis patients, administering large doses over a short period of time increases patients' risk of developing serious infections, according to a study appearing in an upcoming issue of the Journal of the American Society of Nephrology (JASN). Smaller doses given for a longer period of time appears to be much safer.

often develop anemia, or low levels of , and must receive intravenous treatments of to correct the condition. Unfortunately, intravenous iron may promote and impair the , and treated patients face an increased risk of infection. No large studies have looked at how different iron dosing regimens might influence this risk.

To investigate, Maurice Alan Brookhart, PhD (University of North Carolina, Chapel Hill) and his colleagues assessed the safety of commonly used intravenous iron dosing practices in dialysis patients with respect to infection risk. In particular, they compared the safety of providing a large amount of iron over a short period of time (called bolus or repletion dosing) vs providing smaller, less frequent administrations (called maintenance dosing). The researchers analyzed clinical information from 117,050 patients followed for three months. Of these, 12% received bolus dosing, 49% received maintenance dosing, and 38% received no iron.

Among the major findings:

  • Bolus dosing was associated with increased risks of serious infection and infection-related death. (There were 25 additional infections per 1000 patient-years compared with maintenance dosing.)
  • These risks were particularly high among patients who used a for dialysis (73 additional infections per 1000 patient-years) and for those with a history of recent infection (57 additional infections per 1000 patient-years).
  • There was no evidence of infection risk associated with maintenance dosing compared with no iron administration.

"Although administration of iron is a necessary to manage in hemodialysis patients, our results suggest that providing a large amount of iron over a short time may increase the risk of serious infections in dialysis patients. Smaller, less frequent doses of iron appear to be safer," said Dr. Brookhart.

In an accompanying editorial, Connie Rhee, MD, and Kamyar Kalantar-Zadeh, MD, PhD (University of California Irvine School of Medicine) noted that because the study is an observational one, more research is needed. "To date no randomized controlled studies have been conducted to substantiate the risk of increased infection or death as a result of IV iron therapy in dialysis patients," they wrote.

Explore further: Study examines global management of anemia in children on dialysis

More information: The article, entitled "Intravenous Iron Supplementation Practices and Infection Risk in Hemodialysis Patients," will appear online on June 20, 2013, doi: 10.1681/ASN.2012121164
The editorial, entitled "Is Iron Maintenance Therapy Better Than Load and Hold?" will appear online on June 20, 2013, doi: 10.1681/ASN.2013050456

Related Stories

Infections may be deadly for many dialysis patients

May 24, 2012

An infection called peritonitis commonly arises in the weeks before many dialysis patients die, according to a study appearing in an upcoming issue of the Journal of the American Society of Nephrology (JASN). The findings ...

Recommended for you

Zika virus infection alters human and viral RNA

October 20, 2016

Researchers at University of California San Diego School of Medicine have discovered that Zika virus infection leads to modifications of both viral and human genetic material. These modifications—chemical tags known as ...

Food-poisoning bacteria may be behind Crohn's disease

October 19, 2016

People who retain a particular bacterium in their gut after a bout of food poisoning may be at an increased risk of developing Crohn's disease later in life, according to a new study led by researchers at McMaster University.

Neurodevelopmental model of Zika may provide rapid answers

October 19, 2016

A newly published study from researchers working in collaboration with the Regenerative Bioscience Center at the University of Georgia demonstrates fetal death and brain damage in early chick embryos similar to microcephaly—a ...

Scientists uncover new facets of Zika-related birth defects

October 17, 2016

In a study that could one day help eliminate the tragic birth defects caused by Zika virus, scientists from the Florida campus of The Scripps Research Institute (TSRI) have elucidated how the virus attacks the brains of newborns, ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.