title: Receipt of Intravenous Iron and Clinical Outcomes among Hemodialysis Patients Hospitalized for Infection.
abstract: OBJECTIVE
  Anemia guidelines for CKD recommend withholding intravenous iron in the setting of active infection, although no data specifically support this recommendation. This study aimed to examine the association between intravenous iron and clinical outcomes among hemodialysis patients hospitalized for infection.
  
  
  METHODS
  This was a retrospective observational cohort study using data from the US Renal Data System of 22,820 adult Medicare beneficiaries on in-center hemodialysis who had received intravenous iron in the 14 days preceding their first hospitalization for bacterial infection in 2010. In multivariable analyses, the association between receipt of intravenous iron at any point from the day of hospital admission to discharge and all-cause 30-day mortality, mortality in 2010, length of hospital stay, and readmission for infection or death within 30 days of discharge was evaluated.
  
  
  RESULTS
  There were 2463 patients (10.8%) who received intravenous iron at any point from the day of admission to discharge. Receipt of intravenous iron was not associated with age, dialysis vintage, or comorbidities. There were 2618 deaths within 30 days of admission and 6921 deaths in 2010 (median follow-up 173 days; 25th and 75th percentiles, 78-271 days). The median length of stay was 7 days (25th and 75th percentiles, 5-12 days). Receipt of intravenous iron was not associated with higher 30-day mortality (odds ratio, 0.86; 95% confidence interval [95% CI], 0.74 to 1.00), higher mortality in 2010 (hazard ratio, 0.92; 95% CI, 0.85 to 1.00), longer mean length of stay (10.1 days [95% CI, 9.7 to 10.5] versus 10.5 days [95% CI, 10.3 to 10.7]; P=0.05), or readmission for infection or death within 30 days of discharge (odds ratio, 1.08; 95% CI, 0.96 to 1.22) compared with no receipt of intravenous iron.
  
  
  CONCLUSIONS
  This analysis does not support withholding intravenous iron upon admission for bacterial infection in hemodialysis patients, although clinical trials are required to make definitive recommendations.
authors.affiliation: Divisions of Nephrology and Division of Nephrology, Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California; and julie.ishida@ucsf.edu.
authors.forename: Julie H
authors.initials: JH
authors.lastname: Ishida
authors.affiliation: Center for Healthcare Value, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California;
authors.forename: Ben J
authors.initials: BJ
authors.lastname: Marafino
authors.affiliation: Epidemiology and Biostatistics.
authors.forename: Charles E
authors.initials: CE
authors.lastname: McCulloch
authors.affiliation: Division of Nephrology, Department of Medicine, University of California, Davis, California.
authors.forename: Lorien S
authors.initials: LS
authors.lastname: Dalrymple
authors.affiliation: Center for Healthcare Value, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California; Epidemiology and Biostatistics, Pulmonary and Critical Care, Departments of Medicine and.
authors.forename: R Adams
authors.initials: RA
authors.lastname: Dudley
authors.affiliation: Epidemiology and Biostatistics.
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Grimes
authors.affiliation: Divisions of Nephrology and Division of Nephrology, Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California; and Epidemiology and Biostatistics.
authors.forename: Kirsten L
authors.initials: KL
authors.lastname: Johansen
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D000740:Anemia / Q000188:drug therapy* / Q000209:etiology; D016470:Bacteremia / Q000209:etiology; D055499:Catheter-Related Infections / Q000150:complications; D002423:Cause of Death; D016208:Databases, Factual; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007501:Iron / Q000008:administration & dosage* / Q000009:adverse effects; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality* / Q000628:therapy*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D006435:Renal Dialysis; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D058017:Vascular Grafting / Q000009:adverse effects
chemical_list: D007501:Iron
keywords: hemodialysis; infection; iron