Infection Risk with Bolus versus Maintenance Iron Supplementation in Hemodialysis Patients
Infection Risk with Bolus versus Maintenance Iron Supplementation in Hemodialysis Patients
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DOI：
10.1681/asn.2012121164
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发表时间：
2013-07-01
影响因子：
13.6
通讯作者：
Kshirsagar, Abhijit V.
中科院分区：
文献类型：
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作者：
Brookhart, M. Alan;Freburger, Janet K.;Kshirsagar, Abhijit V.
静脉注射铁剂可能促进细菌生长并损害宿主防御，但与补铁相关的感染风险尚未明确。我们对血液透析患者进行了一项回顾性队列研究，以比较推注给药（根据需要在短时间内提供大量铁）与维持给药（定期提供少量铁以维持铁补充）的安全性。使用来自美国一家大型透析提供商的117，050名患者的临床数据与来自医疗保险ESRD计划的数据合并，我们估计了在重复1个月暴露期间铁剂量模式对随后3个月死亡率和感染相关住院风险的影响。在776，203对暴露/随访中，13%涉及推注给药，49%涉及维持给药，38%不包括铁暴露。多变量加性风险模型发现，在随访期间，接受推注与维持铁剂的患者感染相关住院的风险增加（风险差异[RD]，25起额外事件/1000患者-年; 95%置信区间[CI]，16 - 33）。导管患者（RD，73起事件/1000患者-年; 95% CI，48 - 99）和近期感染患者（RD，57起事件/1000患者-年; 95% CI，19 - 99）的风险最大。我们还观察到推注剂量与感染相关死亡率之间的相关性。与无铁相比，维持剂量与不良结局风险增加无关。这些结果表明，维持性补铁可能导致比推注剂量更少的感染，特别是在导管患者中。
Intravenous iron may promote bacterial growth and impair host defense, but the risk of infection associated with iron supplementation is not well defined. We conducted a retrospective cohort study of hemodialysis patients to compare the safety of bolus dosing, which provides a large amount of iron over a short period of time on an as-needed basis, with maintenance dosing, which provides smaller amounts of iron on a regular schedule to maintain iron repletion. Using clinical data from 117,050 patients of a large US dialysis provider merged with data from Medicare's ESRD program, we estimated the effects of iron dosing patterns during repeated 1-month exposure periods on risks of mortality and infection-related hospitalizations during the subsequent 3 months. Of 776,203 exposure/follow-up pairs, 13% involved bolus dosing, 49% involved maintenance dosing, and 38% did not include exposure to iron. Multivariable additive risk models found that patients receiving bolus versus maintenance iron were at increased risk of infection-related hospitalization (risk difference [RD], 25 additional events/1000 patient-years; 95% confidence interval [CI], 16 to 33) during follow-up. Risks were largest among patients with a catheter (RD, 73 events/1000 patient-years; 95% CI, 48 to 99) and a recent infection (RD, 57 events/1000 patient-years; 95% CI, 19 to 99). We also observed an association between bolus dosing and infection-related mortality. Compared with no iron, maintenance dosing did not associate with increased risks for adverse outcomes. These results suggest that maintenance iron supplementation may result in fewer infections than bolus dosing, particularly among patients with a catheter.