|Iron dosing regimens affect dialysis patientsí infection risk|
|June 20, 2013|
While intravenous iron is critical for maintaining the health of many dialysis patients, administering large doses over a short period of time may increase patients' risk of developing serious infections, according to a study led by Alan Brookhart, PhD, associate professor of epidemiology at Gillings School of Global Public Health.
The study, published online June 20 in the Journal of the American Society of Nephrology, reports that a regimen of smaller doses given for a longer period of time appears to be much safer.
Dialysis patients often develop severe anemia, or low levels of red blood cells, and receive intravenous treatments of iron to help correct the condition. There have been concerns that intravenous iron may promote bacterial growth and lead to increased risk of infection. However, no large studies have examined how different iron dosing practices might influence this risk.
To investigate the issue, Brookhart and colleagues assessed the safety of commonly used intravenous iron dosing practices in dialysis patients with respect to infection risk. In particular, they compared the safety of providing a large amount of iron over a short period of time (bolus, or repletion, dosing) as compared to providing smaller, less frequent administrations (maintenance dosing). The researchers analyzed clinical information from 117,050 patients followed for up to three years.
Findings from the study included:
Study co-authors include Janet Freburger, PhD, and Alan R.Ellis, PhD, research associates and fellows at the Cecil G. Sheps Center for Health Services Research; Lily Wang, PhD, UNC biostatistics alumna and applications specialist at the Sheps Center; and Abhijit Kshirsagar, MD, assistant professor of medicine, all at the University of North Carolina at Chapel Hill; and Wolfgang Winkelmayer, MD, ScD, associate professor of medicine at Stanford University School of Medicine.
The article, "Infection Risk with Bolus versus Maintenance Iron Supplementation in Hemodialysis Patients," is available online.
About kidney disease
One in 10 Americans age 20 or older - more than 20 million people - has some level of chronic kidney disease, a phenomenon aggravated by increasing levels of diabetes and hypertension. When a person develops end-stage renal disease (ESRD), the kidneys no longer can filter blood to remove waste and impurities. There is no cure for ESRD; the only lifesaving options are dialysis (mechanical filtering of the blood) or kidney transplant(s).
The emotional, physical and financial burdens of the disease are huge. The national cost for the ESRD program in 2007 was $35.32 billion in public and private spending. The savings to Medicare for each kidney disease patient who does not progress to dialysis is estimated at $250,000. In 2009, Medicare spent $29 billion (6.7 percent of its total budget) on kidney failure.
|Last updated June 21, 2013|