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Adv Chronic Kidney Dis. 2019 Jul;26(4):292-297. doi: 10.1053/j.ackd.2019.05.001.

Long-Term Risks of Intravenous Iron in End-Stage Renal Disease Patients.

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Division of Nephrology and Hypertension, UNC Kidney Center, Chapel Hill, NC. Electronic address:
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA.


Patients with end-stage renal disease on dialysis commonly receive intravenous iron to treat anemia along with erythropoiesis-stimulating agents. While studies of intravenous iron have demonstrated efficacy in raising hemoglobin, the quantity of administered intravenous iron has raised concerns about iron overload leading to long-term toxicities. The goal of this review is to understand recent trends in intravenous iron use, potential mechanisms of iron toxicity, and to evaluate the available evidence in the literature for potential long-term cardiovascular and infectious complications. We include findings from the recently published landmark clinical trial of intravenous iron for patients receiving hemodialysis to contextualize treatment recommendations.


Anemia; Cardiovascular disease; Dialysis; Infection; Intravenous iron safety


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