Abstract: FR-PO0623
Short-Term Infectious Outcomes After Intravenous vs. Oral Iron Therapy: A Target Trial Emulation Study
Session Information
- Anemia: Global Burden, Disease Interactions, and Emerging Therapeutic Paradigms
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Anemia and Iron Metabolism
- 200 Anemia and Iron Metabolism
Authors
- Shrestha, Prabin, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
- Sumida, Keiichi, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
- Thomas, Fridtjof, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
- Kalantar-Zadeh, Kamyar, Harbor-UCLA Medical Center, Torrance, California, United States
- Kovesdy, Csaba P., The University of Tennessee Health Science Center, Memphis, Tennessee, United States
Background
Intravenous (IV) iron is commonly used to treat iron deficiency and iron deficiency anemia. However, concerns remain regarding whether IV iron may increase short-term infection risk. We examined the 30-day risk of infectious outcomes following IV vs. oral iron therapy using a target trial emulation approach.
Methods
We examined a nationwide cohort of N= 40,221 US Veterans with iron deficiency and incident new use of IV or oral iron and no evidence of active infection, recent antimicrobial use, recent hospitalization, immunosuppression, recent iron exposure, or severe anemia requiring transfusion. Patients were followed for 30 days for the composite outcome of infectious hospitalization or infectious mortality. Propensity score overlap weighting was used to balance baseline characteristics between treatment groups. Associations between IV versus oral iron and infectious outcomes were evaluated using competing-risk regression models, with non-infectious death treated as a competing event.
Results
The cohort included 39,001 oral iron users and 1,220 IV iron users. Mean age was 68±12 years, 9% were female, and 78% were White. The baseline eGFR, hemoglobin and ferritin levels were 76±21 ml/min/1.73m2, 11.4±1.8 gm/dL and 15 mcg/l (25th-75th pctl: 9-23), respectively. During 30 days of follow-up, 280 infectious events occurred. In unadjusted analysis, IV iron therapy was associated with higher risk of infectious outcomes compared with oral iron therapy. However, after propensity score overlap weighting, the association was attenuated and no longer statistically significant (subhazard ratio 1.67, 95% CI 0.78-3.57; p=0.2, Table).
Conclusion
In this target trial emulation study of adults with iron deficiency, IV iron therapy (vs. oral iron) was not associated with a higher 30-day risk of infectious outcomes. These findings provide reassurance regarding the short-term infectious safety of IV iron use in contemporary clinical practice.
Association of IV vs oral iron therapy with 30-day risk of infectious outcomes.
| Iron Therapy | Event rate per 1000PY (95% CI) | Un-adjusted SHR (95% CI) | p-value | PS overlap weighted SHR (95% CI) | p-value |
| IV (N=1,220) | 213.60 (122.24, 304.96) | 1.63 (1.02–2.63) | 0.04 | 1.67 (0.78–3.57) | 0.2 |
| Oral (N=39,001) | 81.54 (71.61, 91.47) | Referent | Referent |
Funding
- Veterans Affairs Support