title: Safety of intravenous iron in hemodialysis patients.
abstract: Among end-stage renal disease patients maintained by hemodialysis, anemia has been managed primarily through erythropoiesis-stimulating agents (ESAs) and intravenous (IV) iron. Following concerns about the cardiovascular (CV) safety of ESAs and changes in the reimbursement policies in Medicare's ESRD program, the use of IV iron has increased. IV iron supplementation promotes hemoglobin production and reduces ESA requirements, yet there exists relatively little evidence on the long-term safety of iron supplementation in hemodialysis patients. Labile iron can induce oxidative stress and is also essential in bacterial growth, leading to concerns about IV iron use and risk of CV events and infections in hemodialysis patients. Existing randomized controlled trials provide little evidence about safety due to insufficient power and short follow-up; recent observational studies have been inconsistent, but some have associated iron exposure with increased risk of infections and CV events. Given the widespread use and potential safety concerns related to IV iron, well-designed large prospective studies are needed to assess to identify optimal strategies for iron administration that maximize its benefits while avoiding potential risks.
authors.affiliation: Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.|UNC Kidney Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Xiaojuan
authors.initials: X
authors.lastname: Li
authors.affiliation: UNC Kidney Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Abhijit V
authors.initials: AV
authors.lastname: Kshirsagar
authors.affiliation: Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: M Alan
authors.initials: MA
authors.lastname: Brookhart
mesh_terms: D000740:Anemia / Q000188:drug therapy*; D004342:Drug Hypersensitivity; D006801:Humans; D007275:Injections, Intravenous; D007501:Iron / Q000008:administration & dosage* / Q000009:adverse effects; D007676:Kidney Failure, Chronic / Q000628:therapy; D006435:Renal Dialysis / Q000009:adverse effects*
chemical_list: D007501:Iron
keywords: Anemia; infections; safety issues