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