Is iron therapy for anemia harmful in the setting of infection?

Daoud, Ehab; Nakhla, Engi; Sharma, Reecha

doi:10.3949/ccjm.78a.10156

Cited by 8 publications

(7 citation statements)

References 26 publications

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“…Although some recommend withholding iron during acute infection, [25][26][27][28] others argue that the evidence supporting this recommendation is weak. 21,29 We also observed an association between dosing practices and risk of infection-related mortality. The existing epidemiologic evidence linking iron exposure and mortality is inconclusive, with some studies finding evidence of harm, 30,31 one study finding no association, 32 and one study finding benefits in patients with severe anemia but risks in patients with mild anemia.…”

Section: Discussionmentioning

confidence: 55%

Infection Risk with Bolus versus Maintenance Iron Supplementation in Hemodialysis Patients

Brookhart

Freburger

Ellis

et al. 2013

Journal of the American Society of Nephrology

137

122

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Intravenous iron may promote bacterial growth and impair host defense, but the risk of infection associated with iron supplementation is not well defined. We conducted a retrospective cohort study of hemodialysis patients to compare the safety of bolus dosing, which provides a large amount of iron over a short period of time on an as-needed basis, with maintenance dosing, which provides smaller amounts of iron on a regular schedule to maintain iron repletion. Using clinical data from 117,050 patients of a large US dialysis provider merged with data from Medicare's ESRD program, we estimated the effects of iron dosing patterns during repeated 1-month exposure periods on risks of mortality and infection-related hospitalizations during the subsequent 3 months. Of 776,203 exposure/follow-up pairs, 13% involved bolus dosing, 49% involved maintenance dosing, and 38% did not include exposure to iron. Multivariable additive risk models found that patients receiving bolus versus maintenance iron were at increased risk of infection-related hospitalization (risk difference [RD], 25 additional events/1000 patient-years; 95% confidence interval [CI], 16 to 33) during follow-up. Risks were largest among patients with a catheter (RD, 73 events/1000 patient-years; 95% CI, 48 to 99) and a recent infection (RD, 57 events/1000 patient-years; 95% CI, 19 to 99). We also observed an association between bolus dosing and infection-related mortality. Compared with no iron, maintenance dosing did not associate with increased risks for adverse outcomes. These results suggest that maintenance iron supplementation may result in fewer infections than bolus dosing, particularly among patients with a catheter.

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Section: Discussionmentioning

confidence: 55%

Infection Risk with Bolus versus Maintenance Iron Supplementation in Hemodialysis Patients

Brookhart

Freburger

Ellis

et al. 2013

Journal of the American Society of Nephrology

137

122

View full text Add to dashboard Cite

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“…Yu et al [75] used the SPION preparation ferucarbotran to image livers in 109 patients with chronic viral hepatitis and did not report any infectious complications. Additional reports are in consensus that hemodialysis patients supplemented with IV iron do not appear to be at an increased risk of infection [76, 77]. …”

Section: Does IV Iron Increase the Risk Of Infection?mentioning

confidence: 99%

Iron-Based Superparamagnetic Nanoparticle Contrast Agents for MRI of Infection and Inflammation

Neuwelt

Sidhu

et al. 2015

American Journal of Roentgenology

131

111

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OBJECTIVE In this article, we summarize the progress to date on the use of superparamagnetic iron oxide nanoparticles (SPIONs) as contrast agents for MRI of inflammatory processes. CONCLUSION Phagocytosis by macrophages of injected SPIONs results in a prolonged shortening of both T2 and T2* leading to hypointensity of macrophage-infiltrated tissues in contrast-enhanced MR images. SPIONs as contrast agents are therefore useful for the in vivo MRI detection of macrophage infiltration, and there is substantial research and clinical interest in the use of SPION-based contrast agents for MRI of infection and inflammation. This technique has been used to identify active infection in patients with septic arthritis and osteomyelitis; importantly, the MRI signal intensity of the tissue has been found to return to its un-enhanced value on successful treatment of the infection. In SPION contrast-enhanced MRI of vascular inflammation, animal studies have shown decreased macrophage uptake in atherosclerotic plaques after treatment with statin drugs. Human studies have shown that both coronary and carotid plaques that take up SPIONs are more prone to rupture and that abdominal aneurysms with increased SPION uptake are more likely to grow. Studies of patients with multiple sclerosis suggest that MRI using SPIONs may have increased sensitivity over gadolinium for plaque detection. Finally, SPIONs have enabled the tracking and imaging of transplanted stem cells in a recipient host.

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“…Current adjuvant therapies, including intravenouslyadministered iron, erythropoiesis-stimulating agents, and erythrocyte transfusions, have limited efficacy and important side effects. [5][6][7] Research has focused on the development of new therapeutic agents targeting hepcidin, 8 including inhibitors of hepcidin synthesis. Among them, LDN-193189, a BMP type I receptor inhibitor that is a derivative of dorsomorphin, has been reported to increase hemoglobin levels in animal models of AI.…”

mentioning

confidence: 99%

Oral administration of a bone morphogenetic protein type I receptor inhibitor prevents the development of anemia of inflammation

et al. 2014

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Is iron therapy for anemia harmful in the setting of infection?

Cited by 8 publications

References 26 publications

Infection Risk with Bolus versus Maintenance Iron Supplementation in Hemodialysis Patients

Infection Risk with Bolus versus Maintenance Iron Supplementation in Hemodialysis Patients

Iron-Based Superparamagnetic Nanoparticle Contrast Agents for MRI of Infection and Inflammation

Oral administration of a bone morphogenetic protein type I receptor inhibitor prevents the development of anemia of inflammation

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