IV Iron Therapy in CKD Increases Infection Risk

SAN DIEGO—Non-dialysis chronic kidney disease (CKD) patients receiving intravenous (IV) iron therapy may have increased risks for infection, according to a poster presentation at the American Society of Nephrology’s Kidney Week 2018 conference.

Summer Dyer, PharmD, and colleagues from VA San Diego Healthcare System, compared infection risk in 136 treated and 411 untreated CKD patients at their clinic during 2014 to 2017. Treated patients received IV ferumoxytol 510 mg every week for 2 doses or iron sucrose 200 mg every week for 5 doses. None had end stage renal disease, active infection, or immunosuppression.

At 1 infection (defined as an IV or oral antibiotic prescription) developed in twice as many patients receiving IV iron in the 3 months after their visit: 16.2% vs 8.0%. IV iron recipients had 2.2 times higher risks for infection than non-recipients.

Respiratory and osteomyelitis infections were more common in IV iron users, although sepsis rates were similar between the groups. Hospitalization was required for just 23% of iron users vs 48% of nonusers. The investigators noted that previous studies associated bacterial growth (Escherichia coli and Staphlyococus epidermidis) with iron supplementation.

“The use of intravenous iron therapy has escalated in the treatment of anemia of CKD in order to optimize hemoglobin outcomes with the use of erythropoiesis-stimulating agents,” Dr Dyer and her colleagues concluded. “Thoughtful consideration of the risks and benefits are warranted in prescribing IV iron.”

Reference

Dyer S, Low CL, Nguyen HV. Risk of Infection post intravenous iron therapy in patients with anemia of CKD. Presented at the American Society of Nephrology’s Kidney Week 2018 conference in San Diego, Oct. 23-28. Poster TH-PO242.