Intravenous iron: do we adequately understand the short- and long-term risks in clinical practice?

Area of Science:

• Nephrology
• Hematology
• Pharmacology

Background:

• Intravenous (IV) iron is a vital therapeutic agent, particularly in nephrology, for treating true iron deficiency and iron-restricted anemia.
• Despite proven benefits, inconsistencies exist in the literature regarding IV iron's adverse effects.
• Recent advancements have introduced newer iron formulations, leading to increased usage and higher doses.

Purpose of the Study:

• To review and compare older and newer IV iron products.
• To elucidate the mechanisms and frequency of adverse events (AEs) associated with IV iron.
• To examine underrecognized AEs like hypophosphatemia, infection risk, and potential iron overload.

Main Methods:

• Comprehensive literature review of older and newer studies on IV iron products.
• Analysis of mechanisms and frequency of reported adverse events.
• Examination of recent findings on infection risk, macrophage iron handling, and potential iron overload.

Main Results:

• Newer IV iron formulations are increasingly used, often in higher doses.
• Hypophosphatemia is an underrecognized but significant adverse event.
• Insights into infection risk and macrophage iron handling are evolving.

Conclusions:

• Understanding the nuances of different IV iron products and their associated risks is essential for informed clinical decision-making.
• Careful consideration of the risk:benefit ratio and appropriate dosing is necessary across various clinical settings, including pregnancy and cancer.
• Knowledgeable use of IV iron can optimize anemia therapy and patient outcomes.