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Abstract: TH-PO242

Risk of Infection Post Intravenous Iron Therapy in Patients with Anemia of CKD

Session Information

Category: Anemia and Iron Metabolism

  • 202 Anemia and Iron Metabolism: Clinical

Authors

  • Dyer, Summer, VA San Diego Healthcare System, Cardiff, California, United States
  • Low, Chai L., VA San Diego Healthcare System, Cardiff, California, United States
  • Nguyen, Hugh V., VA San Diego, San Diego, California, United States
Background

The use of intravenous (IV) iron therapy has escalated in the treatment of anemia of chronic kidney disease (CKD) in order to optimize hemoglobin outcomes with the use of erythropoiesis-stimulating agents. The risk of infection associated with IV iron administration in patients with non-dialysis-dependent CKD has not been well defined. The purpose of this study was to investigate the risk of infection in patients with non-dialysis-dependent CKD who have received IV iron versus those patients who have not received IV iron within 3 months post index date.

Methods

This was a retrospective cohort, single center study of patients receiving care at the VA San Diego Healthcare System. Patients were included if they were enrolled in an outpatient CKD clinic from January 1, 2014 to June 1, 2017. Patients were excluded if they had end stage renal disease, active infection, or had an active prescription for immunosuppression therapy. The treatment arm included patients who had received at least one dose of IV iron for treatment of anemia of CKD. The control arm included patients enrolled in CKD clinic who did not receive IV iron during the study period. Control patients were matched to the treatment arm patients in a 3:1 ratio based on the season of their index date. Infection was defined as prescription of IV or PO antibiotic within 3 months post index date. Chi square test was performed to determine statistical significance for our primary outcome.

Results

33 out of the 411 (8.0%) control patients and 22 out of the 136 (16.2%) IV iron patients developed at least one infection over the course of 3 months after the index date (p=0.006). CKD patients who received IV iron where twice as likely to develop an infection versus CKD patients who did not receive IV iron (OR=2.21, 95% CI 1.2-3.9).

Conclusion

This study provides support that the use of IV iron is associated with increased infection risk in the non-dialysis-dependent CKD population. This study however is limited in the ability to account for all baseline confounding variables between our study populations as it is retrospective in nature. A prospective study will be imperative to further investigate this increased risk of infections associated with IV iron therapy. Thoughtful consideration of the risks and benefits are warranted in prescribing IV iron for the treatment of iron deficiency anemia in CKD.