What are the side effects of IV iron?
IV iron may be associated with acute reactions such as nausea/vomiting and hypotension, which are likely related to free iron in the preparation.
IV iron may be associated with allergic or anaphylactic reactions to the carbohydrate that binds the iron.
There have been concerns regarding the long-term effects of IV iron administration, including iron accumulation in tissues, oxidative damage to endothelial cells, and increased susceptibility to infection.
Retrospective studies in HD patients have shown an association with adverse clinical outcomes and monthly IV iron doses over 400 mg, but it is impossible to exclude confounding by indication.
In a prospective study comparing IV and oral iron in patients with nondialysis patients with iron deficiency anemia, patients receiving IV iron had a 2.51 higher incidence of cardiovascular events and a 2.12 increased risk of hospitalization due to infection over a 2-year follow-up period.
This supports the Kidney Disease Improving Global Outcomes recommendation that in patients with nondialysis Chronic kidney disease and iron deficiency anemia, a 1- to 3-month trial of oral iron therapy be considered prior to initiating IV iron therapy.
