A study of intravenous iron exposure in ESRD patients on haemodialysis

Introduction Intravenous iron in combination with erythropoietin therapy is essential in maintaining optimal haemoglobin level. However, data is limited on whether over exposure of iron is associated with increased morbidity and mortality in ESRD patients on haemodialysis (HD), especially infection related. Objectives To evaluate any association between cumulative iron dose and episodes of infections, all cause hospitalizations and mortality in patients on HD. Method All newly diagnosed ESRD patients initiated on HD in Pahang State of Malaysia government dialysis centers between 1 January 2014 and 31 December 2014 were included. Baseline demographics, cumulative iron dose (IV Cosmofer) over 3 months, haemoglobin level, ferritin level and transferrin saturation ratios (TSAT) were recorded. Patients’ outcome of infections, all causes hospitalisations and mortality were analysed. Results There were 123 patients included during which there were 17.9% infections, 43.9% all cause hospitalizations and 4.1% mortality. The mean 3-month cumulative iron dose was 473 + 17 mg and the maximum level was 3300 mg. The haemoglobin level is lower in patients with infections (8.3 + 1.0 g/dl vs 9.8 + 1.7 g/dl, p < 0.05), and in all causes hospitalisations (9.1 g/dl + 1.6 vs 9.8 g/dl + 1.7, p = 0.017). Mortality was associated with lower haemoglobin (7.8 + 1.5 g/dl vs 9.6 + 1.6 g/dl, p = 0.022). There was no significant relation between cumulative iron dose, level of ferritin or TSAT with infection, all causes hospitalisations or mortality. Conclusion Maintaining optimal haemoglobin level is essential to improve patients’ outcome. Increased cumulative iron dose was not related with higher infections, hospitalisations or mortality in our incident HD patients. Further larger prospective studies are needed to further clarify adverse effect, if any, of increased cumulative iron dose