IV iron in patients with CKD reduces Cardiac complications and doesn’t increase infections.

What is it about?

Critics of intravenous (IV) iron have pointed to indirect evidence that iron could cause infections, increase heart attacks, and death. A major trial giving large doses of IV iron to dialysis patients show it is actually safer than lower doses of iron, and does not increase infections. Higher doses of IV iron actually protect against heart complications and death.

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Photo by Joshua Sortino on Unsplash

Photo by Joshua Sortino on Unsplash

Why is it important?

IV iron is relatively inexpensive and reduces the use of Epoetin (or other erythropoiesis stimulating agents (ESA’s). IV iron is essentially ESA’s competitor. The ESA companies for years promoted IV iron as unsafe. Use of IV iron actually saves money by reducing ESA use. ESA’s have been shown to increase the risk of cardiac events, strokes, and death in previous major trials. More IV iron and less ESA is safer for dialysis patients. Similarly, heart failure (HF) is a huge health burden. Trials of IV iron versus placebo have shown iron improves HF patients’ stamina and quality of life, while reducing HF admissions and death. Why is IV iron good for dialysis and HF patients? It appears iron deficiency is more harmful than just mild anemia. In dialysis patients iron deficiency leads to overuse of ESA, which can increase thrombotic events like strokes, other cardiac problems, and even death. In HF, iron deficiency appears to impair increases in cardiac activity with exertion and skeletal muscle function. Iron deficiency limiting HF patients’ physical performance - they feel worse, cannot walk as far, and tend to have more hospitalizations. In both these populations - and likely others - Oral Iron is not effective. Oral iron is not well absorbed in these sick populations, while IV iron bypasses the GI tract and restores iron balance in the body.

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