Intravenous Iron and Infection Risk—Still an Unanswered Question

Abstract

The study by Shah et al 1 reports the results of a meta-analysis of approximately 40 000 individuals who received intravenous (IV) iron in 162 clinical trials, including 154 randomized clinical trials (RCTs).Their findings suggest that IV iron was associated with an increase in the risk of infections (relative risk, 1.17; 95% CI, 1.04-1.31). These findings raise 3 important questions. First: why is this study important; second, why is the evidence to date inconclusive; and third, what is the best way to answer this complex question?Iron is an essential nutrient for both humans and pathogenic microorganisms. 2 Regulation of iron distribution in the body functions as part of an innate immune response against invading pathogens. 2 Infusion of large amounts of iron can potentially subvert the body's protective iron sequestering response. Extracellularly, iron is bound to transferrin, with nontransferrin bound iron only found in the circulation in pathological states. Administration of IV iron is known to generate nontransferrin bound iron, which, in animal studies, has been shown to enhance the growth of siderophilic bacteria. 3 This is the biological basis for concern about infectious complications of IV iron, a drug that has been increasing in use. Thus, it is important to determine whether IV iron increases infection risk.

Uso De Ferro Parenteral

“…Essa alteração metabólica é mais desencadeado após uso de doses elevadas a longo prazo e há maior probabilidade de ocorrer em pacientes com deficiência de vitamina D, uso crônico de corticosteróides e outras comorbidades que afetam a absorção óssea (VILACA et al, 2022). Ressalta-se que pacientes com insuficiência renal crônica não costumam ser suscetíveis a hipopotassemia nesses casos, devido a alteração da metabolização do FGF23 (RUND, 2021).…”