Bolus Iron Dosing Hikes Risk of Serious Infection

SAN DIEGO—Bolus dosing of intravenous (IV) iron is associated with an elevated risk of infection-related hospitalization among anemic hemodialysis (HD) patients compared with maintenance dosing, according to findings presented at Kidney Week 2012.

The investigators, led by M. Alan Brookhart, PhD, of the University of North Carolina in Chapel Hill, studied 117,050 HD patients, of whom 9,033 (16.3%) received a bolus administration, 55,457 (47.4%) received maintenance therapy, and 42,560 (36.4%) received no iron during a one-month exposure assessment period.

During a three-month follow-up, patients receiving bolus iron (a large amount of iron over a short period of time) had an increased risk of infection-related hospitalization (4.3 additional hospitalizations per 100 patient-years) compared with patients receiving maintenance iron therapy (small administrations of iron designed to maintain iron repletion). Patients who received more than 200 mg of iron per month had an additional 2.0 infection-related hospitalizations per 100 patient-years.

Dr. Brookhart's team observed no significant association between bolus dosing and cardiovascular-related hospitalizations and mortality. Furthermore, maintenance dosing was not associated with an increased risk of adverse outcomes compared with no iron supplementation.

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