Hoen B, Paul-Dauphin A, Kessler M
Service de Maladies Infectieuses et Tropicales, Hĵpital Saint-Jacques, Besançon, France.
Clin Nephrol. 2002 Jun;57(6):457-61. doi: 10.5414/cnp57457.
Correction of iron deficiency is critical in chronic hemodialysis patients, and intravenous administration is superior to the oral route in this goal. Recently, concern was raised that intravenous iron administration might promote infection in dialysis patients.
We reviewed the data from a recent prospective study of 985 patients in which no link between iron therapy and bacteremia had been found. We tested the potential role of the administration route of the iron (intravenous vs. oral), the weekly amount of iron administered and the administration rate on the risk for bacteremia in these patients.
were 4-fold: in multivariate analysis, neither intravenous iron administration in the whole population nor the weekly amount of iron in the subgroup of i.v. iron-treated patients were significant risk factors for bacteremia; iron was not given more frequently intravenously in bacteremic than in non-bacteremic patients; among patients treated with intravenous iron, the frequency and the amount of iron administered were significantly higher in those who developed bacteremia than in those who did not; and in patients receiving i.v. iron, there was an increased risk of bacteremia associated with concurrent administration of erythropoietin, which was not observed in patients receiving iron orally.
This study failed to demonstrate a significant association between intravenous iron administration and the risk of bacteremia in dialysis patients. However, there might be a slightly increased risk of bacteremia in patients given high-frequency, high-dose intravenous iron.
纠正缺铁对慢性血液透析患者至关重要，在这一目标上静脉给药优于口服途径。最近，有人担心静脉补铁可能会增加透析患者感染的风险。
我们回顾了最近一项对985例患者的前瞻性研究数据，该研究未发现铁剂治疗与菌血症之间存在关联。我们测试了铁剂的给药途径（静脉注射与口服）、每周铁剂给药量以及给药速率对这些患者菌血症风险的潜在作用。
有4倍差异：在多变量分析中，整个人群中的静脉补铁以及静脉补铁治疗患者亚组中的每周铁剂给药量均不是菌血症的显著危险因素；菌血症患者静脉补铁的频率并不高于非菌血症患者；在接受静脉补铁的患者中，发生菌血症的患者补铁的频率和剂量显著高于未发生菌血症的患者；并且在接受静脉补铁的患者中，同时使用促红细胞生成素会增加菌血症风险，而口服铁剂的患者未观察到这种情况。
本研究未能证明静脉补铁与透析患者菌血症风险之间存在显著关联。然而，高频、高剂量静脉补铁的患者菌血症风险可能会略有增加。
