Intravenous Iron Replacement Creates More Safety Issues

INDIANAPOLIS—Anemia in chronic kidney disease is common, and iron deficiency is an important cause of anemia in chronic kidney disease, but what is the best way to replace the iron needed to repair it?

A study published in the journal Hemodialysis International made an effort to answer to that question.1

The study out of the Richard L. Roudebush VAMC and the Indiana University School of Medicine, both in Indianapolis, pointed out that iron can be replaced either by the oral route or by the intravenous route.

In a meta-analysis, five of six were short-term, one to three months, and compared to oral iron, the mean increase in hemoglobin with intravenous iron was only 0.31 g/dL. The report noted that one of the studies included in this meta-analysis was six months long, however, and had a mean decline in hemoglobin of 0.52 g/dL associated with intravenous iron administration.

“Given the short duration of most of the clinical trials comparing oral with intravenous administration of iron the long-term safety of these modes of administration of supplemental iron could not be assessed,” according to the study, which added that replacement of iron by the oral route is associated with mostly minor complications such as black stools, constipation and abdominal discomfort.

“In contrast, intravenous administration of iron may lead to severe adverse events such as anaphylaxis and, as a more recent randomized trial has suggested, delayed complications such as infections and cardiovascular disease,” the article stated.

The authors explained that delayed complications of repeated intravenous iron use are difficult to recognize at an individual level, suggesting, “inpatients who have had recent cardiovascular events or are infected, intravenous iron should probably be avoided.”

“Balancing safety and efficacy would require clinical judgment because one size may not fit all till we have better data to support the liberal use of parenteral iron,” the study concluded.

1 Agarwal R. Iron deficiency anemia in chronic kidney disease: Uncertainties and cautions. Hemodial Int. 2017 Jun;21 Suppl 1:S78-S82. doi: 10.1111/hdi.12561. Epub 2017 Apr 12. Review. PubMed PMID: 28403561.

Comments (2)

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  1. Neville says:

    Reference 1 was published in Hemodialysis International, not in Annals of Hematology, as per your article. Please make correction if appropriate.

    • Brenda L. Mooney US Medicine editorial director says:

      Thanks for the head’s up. It was my error and has been corrected online.

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