Risk of Infection with Intravenous Iron Therapy

Maynor, Lena; Brophy, Donald F.

doi:10.1345/aph.1k187

Cited by 47 publications

(34 citation statements)

References 20 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: 54%

“…[11][12][13][14][15] Although the role of iron in bacterial growth and infection risk is biologically plausible and has been shown in animal models, 12,[20][21][22] data from large CKD populations on iron and infections are lacking. An abstract reported that frequency of iron administration was associated with increased risk of infection-related mortality in ESRD.…”

Section: Discussionmentioning

confidence: 99%

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Infection Risk with Bolus versus Maintenance Iron Supplementation in Hemodialysis Patients

Brookhart

Freburger

Ellis

et al. 2013

Journal of the American Society of Nephrology

138

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: 54%

Section: Discussionmentioning

confidence: 99%

Infection Risk with Bolus versus Maintenance Iron Supplementation in Hemodialysis Patients

Brookhart

Freburger

Ellis

et al. 2013

Journal of the American Society of Nephrology

138

122

View full text Add to dashboard Cite

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“…As a result, the practice of administering IV iron to patients with systemic infection is generally avoided in clinical practice, in large part on the basis of animal studies showing worsening of systemic infections in subjects treated with IV iron [78–80]. …”

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

133

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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“…In this case, DCI level was 18.59 μM and such a high concentration of this NTBI fraction could be caused by intrauterine infection of the newborn. It has been shown that iron is significant in bacterial metabolism and can promote infection .…”

Section: Resultsmentioning

confidence: 99%

Ability to determine the desferrioxamine‐chelatable iron fractions of nontransferrin‐bound iron using HPLC

Koba

Słomka

Bączek

et al. 2013

J of Separation Science

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Iron is an essential element in human development. It is imperative for oxygen and electron transport and also for DNA and neurotransmitters synthesis. On the other hand, this metal is able to participate in Fenton's reaction that in turn leads to free radical damage. The most toxic fraction of iron - nontransferrin-bound iron and its part desferrioxamine-chelatable iron - can serve as an exquisite biomarker in the identification of iron imbalance. The goal of the present study was to devise a simple, repeatable, and inexpensive method for the determination of desferrioxamine-chelatable iron in serum blood samples. The assay procedure is based on desferrioxamine complex formation with iron ions followed to ferrioxamine and its quantitative measurement using RP-HPLC method. The desferrioxamine-chelatable iron was extracted from blood by centrifugation and SPE method. Chromatographic separation was performed at 40°C by step-form gradient elution using Cadenza CD-C18 column (150 × 4.6 mm id, particle size of 3.0 μm) connected with precolumn for contaminants removal. Gradient HPLC elution has been carried out with solvent A (10 mM Tris-HCl, pH 5.5) and solvent B (ACN). The flow rate was 1.2 mL/min, and the total separation time was 5 min. The linear quantitation range was 2.5-500 μM (r = 0.9973), and the LOD and LOQ were 0.42 and 1.29 μM, respectively. Proposed HPLC method allowed for the determination of desferrioxamine-chelatable iron fraction's of nontransferrin-bound iron, both in the buffer and the serum supplemented with iron ions as well as in the patients' serum samples with good results of precision and recovery. The developed method found to be sufficiently precise and reproducible for established conditions and after validation and may be used for routine assay of desferrioxamine-chelatable iron in biological samples.

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Risk of Infection with Intravenous Iron Therapy

Cited by 47 publications

References 20 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

Ability to determine the desferrioxamine‐chelatable iron fractions of nontransferrin‐bound iron using HPLC

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