Safety of Intravenous Iron in Hemodialysis Patients

Overview

Journal Hemodial Int

Date 2017 Apr 4

PMID 28370957

Citations 12

Authors

Xiaojuan Li

Abhijit V Kshirsagar

M Alan Brookhart

Affiliations

Soon will be listed here.

Abstract

Among end-stage renal disease patients maintained by hemodialysis, anemia has been managed primarily through erythropoiesis-stimulating agents (ESAs) and intravenous (IV) iron. Following concerns about the cardiovascular (CV) safety of ESAs and changes in the reimbursement policies in Medicare's ESRD program, the use of IV iron has increased. IV iron supplementation promotes hemoglobin production and reduces ESA requirements, yet there exists relatively little evidence on the long-term safety of iron supplementation in hemodialysis patients. Labile iron can induce oxidative stress and is also essential in bacterial growth, leading to concerns about IV iron use and risk of CV events and infections in hemodialysis patients. Existing randomized controlled trials provide little evidence about safety due to insufficient power and short follow-up; recent observational studies have been inconsistent, but some have associated iron exposure with increased risk of infections and CV events. Given the widespread use and potential safety concerns related to IV iron, well-designed large prospective studies are needed to assess to identify optimal strategies for iron administration that maximize its benefits while avoiding potential risks.

Citing Articles

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Wang X, Wei C, Zhao D, Sun X, Zhu F, Mei Y Kidney Dis (Basel). 2023; 9(6):485-497.

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The Switch from Ferric Gluconate to Ferric Carboxymaltose in Hemodialysis Patients Acts on Iron Metabolism, Erythropoietin, and Costs: A Retrospective Analysis.

Lacquaniti A, Gargano R, Campo S, Casuscelli di Tocco T, Schifilliti S, Monardo P Medicina (Kaunas). 2023; 59(6).

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Iron Therapy in Chronic Kidney Disease: Days of Future Past.

Lee K, Ho Y, Tarng D Int J Mol Sci. 2021; 22(3).

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Long-Term Prognosis of Hyperferritinemia Induced by Intravenous Iron Therapy in Patients Undergoing Maintenance Hemodialysis: A 10-Year, Single-Center Study.

Maeda S, Konishi R, Morinishi T, Shimizu Y, Nishio H, Takaori K Int J Nephrol. 2020; 2020:8864400.

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Plasma Protein Carbonyls as Biomarkers of Oxidative Stress in Chronic Kidney Disease, Dialysis, and Transplantation.

Colombo G, Reggiani F, Angelini C, Finazzi S, Astori E, Garavaglia M Oxid Med Cell Longev. 2020; 2020:2975256.

PMID: 33299524 PMC: 7707964. DOI: 10.1155/2020/2975256.

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