For hemodialysis (HD) patients, bolus dosing of iron is associated with an increased risk of infection-related hospitalization compared with receiving maintenance iron dosing, especially for patients with a catheter or with recent infection, according to a study published online in the Journal of the American Society of Nephrology.

M. Alan Brookhart, PhD, of the University of North Carolina in Chapel Hill, and colleagues conducted a retrospective study using clinical data from 117,050 hemodialysis patients of a large U.S. dialysis provider linked with data from Medicare’s end-stage renal disease program. The effects of bolus dosing and maintenance dosing on the risks of mortality and infection-related hospitalizations during the subsequent three months were compared during repeated one-month exposure periods.

Of 776,203 exposure/follow-up pairs, 13% used bolus dosing, 49% had maintenance dosing, and 38% did not receive iron. In multivariate analysis, patients receiving bolus iron were at increased risk of infection-related hospitalization (risk difference [RD], 25 additional events/1,000 patient-years) compared with those receiving maintenance iron. Patients with a catheter (RD, 73 events/1,000 patient-years) and a recent infection (RD, 57 events/1,000 patient-years) had the highest risks of infection-related hospitalization. Bolus dosing was also associated with infection-related mortality. Maintenance dosing was not associated with increased risks for adverse outcomes, compared with receiving no iron.

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“These results suggest that maintenance iron supplementation may result in fewer infections than bolus dosing, particularly among patients with a catheter,” the authors concluded.