Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2015 Oct 7;10(10):1799-805.
doi: 10.2215/CJN.01090115. Epub 2015 Sep 28.

Receipt of Intravenous Iron and Clinical Outcomes among Hemodialysis Patients Hospitalized for Infection

Julie H Ishida  1 , Ben J Marafino  2 , Charles E McCulloch  3 , Lorien S Dalrymple  4 , R Adams Dudley  5 , Barbara A Grimes  3 , Kirsten L Johansen  6
Affiliations
Observational Study

Receipt of Intravenous Iron and Clinical Outcomes among Hemodialysis Patients Hospitalized for Infection

Julie H Ishida et al. Clin J Am Soc Nephrol. .

Abstract

Background and objectives: 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.

Design, setting, participants, & measurements: 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.

Keywords: hemodialysis; infection; iron.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Cohort selection. Inclusion and exclusion criteria and selection of the cohort are shown. IV, intravenous.
See this image and copyright information in PMC

Comment in

References

    1. Kidney Disease Improving Global Outcomes (KDIGO) Anemia Work Group : KDIGO clinical practice guideline for anemia in chronic kidney disease. Kidney Int Suppl 2: 279–335, 2012
    1. Fishbane S: Review of issues relating to iron and infection. Am J Kidney Dis 34[Suppl 2]: S47–S52, 1999 - PubMed
    1. Sunder-Plassmann G, Patruta SI, Hörl WH: Pathobiology of the role of iron in infection. Am J Kidney Dis 34[Suppl 2]: S25–S29, 1999 - PubMed
    1. Mencacci A, Cenci E, Boelaert JR, Bucci P, Mosci P, Fè d’Ostiani C, Bistoni F, Romani L: Iron overload alters innate and T helper cell responses to Candida albicans in mice. J Infect Dis 175: 1467–1476, 1997 - PubMed
    1. Khan FA, Fisher MA, Khakoo RA: Association of hemochromatosis with infectious diseases: Expanding spectrum. Int J Infect Dis 11: 482–487, 2007 - PubMed

Publication types

MeSH terms