Effect of intravenous iron on outcomes of acute kidney injury

Abstract

We were unable to find any adverse consequences of use of IV iron when used to treat anemia in patients with AKI in regard to recovery of AKI or mortality even in patients with a diagnosis of sepsis. Consideration of preemptive use of IV iron in AKI with severe anemia is warranted to determine if this would reduce RBC transfusion.

Iron Homeostasis and Ferritin in Sepsis-Associated Kidney Injury

“…Iron supplementation was associated with a decrease in all-cause mortality and a reduced sepsis-related mortality rate in a cohort of dialysis patients [2]. Conversely, intravenous iron supplementation of patients with SA-AKI had no significant effect on recovery of AKI or mortality [3]. However, in contrast, another study showed that parenteral iron supplementation given at the time of sepsis resulted in worse outcomes due to an increase in oxidative stress and tumor necrosis factor-alpha (TNF-α) [4].…”

Iron: a double‐edged sword

“…Or would it be better to treat these patients’ presumed iron deficiency with IV iron infusions, which definitely would increase non–transferrin‐bound iron levels? Although there were prior concerns about the use of IV iron because of its association with severe anaphylactic reactions, these concerns have been mitigated by the development of new formulations, which can be safely used in multiple settings . Therefore, IV iron is now used more frequently and for a wider array of indications, thereby supporting the timeliness of the current paper …”

Iron deficiency in sepsis patients managed with divided doses of iron dextran: a prospective cohort study

“…We did not analyze any other adverse effects of intravenous iron complex used in the study. Clark et al investigated the effect of intravenous iron in AKI patients, pointing out that anemia may be even more widespread among patients with AKI, where endogenous erythropoietin (Epo) production is usually impaired 40 . Intravenous iron is well-known to optimize anemia and minimize Epo use in chronic kidney disease (CKD) population 41 – 44 .…”

“…Clark et al retrospectively analyzed 134 patients diagnosed with AKI, 67 patients who received intravenous iron and 67 controls. The authors concluded that there were no adverse consequences of intravenous iron used to treat resistant anemia in patients with AKI—no negative effect of intravenous iron on recovery of AKI or mortality was seen, not even in sepsis inpatients receiving antibiotics 40 . We feel that there is room for further research regarding risk–benefit of intravenous iron supplementation in patients with sepsis or septic shock.…”