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      Receipt of Intravenous Iron and Clinical Outcomes among Hemodialysis Patients Hospitalized for Infection

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          Abstract

          Background and objectives

          Anemia guidelines for CKD recommend withholding intravenous iron in the setting of active infection, although no data specifically support this recommendation. This study aimed to examine the association between intravenous iron and clinical outcomes among hemodialysis patients hospitalized for infection.

          Design, setting, participants, & measurements

          This was a retrospective observational cohort study using data from the US Renal Data System of 22,820 adult Medicare beneficiaries on in-center hemodialysis who had received intravenous iron in the 14 days preceding their first hospitalization for bacterial infection in 2010. In multivariable analyses, the association between receipt of intravenous iron at any point from the day of hospital admission to discharge and all-cause 30-day mortality, mortality in 2010, length of hospital stay, and readmission for infection or death within 30 days of discharge was evaluated.

          Results

          There were 2463 patients (10.8%) who received intravenous iron at any point from the day of admission to discharge. Receipt of intravenous iron was not associated with age, dialysis vintage, or comorbidities. There were 2618 deaths within 30 days of admission and 6921 deaths in 2010 (median follow-up 173 days; 25th and 75th percentiles, 78–271 days). The median length of stay was 7 days (25th and 75th percentiles, 5–12 days). Receipt of intravenous iron was not associated with higher 30-day mortality (odds ratio, 0.86; 95% confidence interval [95% CI], 0.74 to 1.00), higher mortality in 2010 (hazard ratio, 0.92; 95% CI, 0.85 to 1.00), longer mean length of stay (10.1 days [95% CI, 9.7 to 10.5] versus 10.5 days [95% CI, 10.3 to 10.7]; P=0.05), or readmission for infection or death within 30 days of discharge (odds ratio, 1.08; 95% CI, 0.96 to 1.22) compared with no receipt of intravenous iron.

          Conclusions

          This analysis does not support withholding intravenous iron upon admission for bacterial infection in hemodialysis patients, although clinical trials are required to make definitive recommendations.

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          Author and article information

          Journal
          Clin J Am Soc Nephrol
          Clin J Am Soc Nephrol
          clinjasn
          cjn
          CJASN
          Clinical Journal of the American Society of Nephrology : CJASN
          American Society of Nephrology
          1555-9041
          1555-905X
          07 October 2015
          28 September 2015
          : 10
          : 10
          : 1799-1805
          Affiliations
          [* ]Divisions of Nephrology and
          []Pulmonary and Critical Care, Departments of Medicine and
          [§ ]Epidemiology and Biostatistics,
          []Center for Healthcare Value, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California;
          []Division of Nephrology, Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California; and
          []Division of Nephrology, Department of Medicine, University of California, Davis, California
          Author notes
          Correspondence: Dr. Julie H. Ishida, San Francisco Veterans Affairs Medical Center, Nephrology Section, 4150 Clement Street, 111J, San Francisco, CA 94121. Email: julie.ishida@ 123456ucsf.edu
          Article
          PMC4594059 PMC4594059 4594059 01090115
          10.2215/CJN.01090115
          4594059
          26416943
          1e9af13e-269e-4c85-b0c7-e0cc0abe53ea
          Copyright © 2015 by the American Society of Nephrology
          History
          : 30 January 2015
          : 16 June 2015
          Page count
          Pages: 7
          Categories
          Original Articles
          Epidemiology and Outcomes
          Custom metadata
          October 07, 2015

          hemodialysis,iron,infection
          hemodialysis, iron, infection

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