Effects of intravenously administered iron on systemic blood pressure in hemodialysis patients

Although maintenance of iron stores by intravenous iron infusion has become increasingly common in chronic hemodialysis patients, the effects of intravenous iron on blood pressure are not clear.

In 52 mostly African-American patients in an urban setting, we reviewed blood pressure data over the course of hemodialysis on days that intravenous iron was administered and on control days.

The drop in blood pressure from the beginning to the end of hemodialysis was more pronounced when iron was not administered (9.9 +/- 1.2 mm Hg) compared to when iron was administered (4.1 +/- 1.7 mm Hg; p < 0.01). In a subset of chronic hemodialysis patients, blood pressure was actually higher at the end of hemodialysis compared to at the onset (9.6% of control hemodialysis sessions and 32.7% of sessions in which iron was administered; p < 0.01). The incidence of intra-dialytic hypotension and related symptoms was similar on iron and non-iron days.

Intravenous iron therapy, well entrenched in clinical practice for the treatment of the anemia of end-stage renal disease, may reduce the incidence and magnitude of post-dialytic hypotension.