IV Iron Safe for Treating Anemia in Acute Kidney Injury Patients

In a case-control study, the treatment did not adversely affect mortality or recovery from AKI.
In a case-control study, the treatment did not adversely affect mortality or recovery from AKI.

Use of intravenous (IV) iron to treat iron-deficiency anemia in patients with acute kidney injury (AKI) does not adversely affect outcomes, according to researchers.

In a study, Barbara A. Clark, MD, and colleagues at Allegheny General Hospital in Pittsburgh found that IV iron does not impede recovery from AKI or increase mortality risk, even in those with sepsis.

Dr. Clark's group identified 67 AKI patients treated with IV iron (cases) and matched them to 67 AKI patients by age, stage of chronic kidney disease, and severity of anemia and who did not receive IV iron (controls). Cases tended to be sicker than controls, with a longer hospital length of stay (mean 27 vs. 15 days) and more intensive care unit days (mean 13 vs. 5 days), the investigators reported online in Transfusion. The researchers found no significant difference in the need for dialysis (38.8% vs. 34.3% of patients), mortality rate (24% vs. 21%), or severity of and recovery from AKI. The discharge hemoglobin levels were similar (9.0 vs. 9.1 mg/dL).

Iron stores were checked in 76% of cases and 34% of controls. Mean iron saturation was significantly lower in cases than controls (11.8% vs. 29%), but ferritin levels did not differ significantly between the groups.

The researchers noted that not much is known about benefit versus risk in treating iron-deficiency anemia with IV iron in AKI patients. Concerns about adverse outcomes may discourage use of IV iron and could contribute to greater use of red blood cell transfusion, they pointed out. In critically ill patients, they stated, transfusion can enhance oxygen delivery and, theoretically, may be beneficial for AKI patients, but there is little evidence that transfusion is beneficial and possible could be harmful.

Dr. Clark's group acknowledged that their study is limited by its retrospective design. “However, it appears as though there were no adverse consequences of use of IV iron when used to treat resistant anemia in patients with AKI,” they concluded.

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