Intravenous iron dose and frequency determine infection risks

摘要

The KDOQI (Kidney Disease Outcomes Quality Initiative) US commentary on 2012 KDIGO (Kidney Disease: Improving Global Outcomes) Clinical Practice Guideline for Anemia in Chronic Kidney Disease (CKD) stated that current evidence cannot determine whether intravenous (IV) iron increases the risk of infection or worsens outcomes with infection.1 There is increasing data to suggest that infective and adverse-event risks may be related to the intensity and frequency of IV iron dosing.2'3 Brookhart et al3 studied iron dosing patterns in a retrospective cohort of 117,050 prevalent hemodialysis patients and found that administration of large boluses of IV iron for repleting iron deficiency was associated with increased infection-related hospitalization or death (adjusted hazard ratio, 1.08; 95% confidence interval, 1.05-1.11) compared with smaller doses of IV iron maintenance therapy. The risk of infection-related hospitalization was increased further in patients who had experienced infection within the past month. A recent meta-analysis of randomized controlled trials evaluating IV iron use (often administered as frequent boluses) in patients with varying infective risk profiles found IV iron to be associated with 30% greater risk of infection compared to oral or no iron therapy.4 Unfortunately, similar trials in patients with CKD seldom report bacterial infections as an end point.5 Thus, large multi-center randomized controlled trials designed to evaluate both short- and long-term safety of different IV iron dosing regimens are still required to determine optimal iron therapy in patients with CKD.