Does IV Iron Increase the Risk of Cardiovascular Disease?
The dialytic milieu is characterized by inflammation, infection, oxidant stress, and the propensity for accelerated atherosclerosis (29). Biologically active iron plays a role in each of these processes. IV iron administration provides a rich source for intradialytic bioactive iron (30). All IV iron agents tested, including iron dextran (31), iron polymaltose (32), iron sucrose (16,31,32), and ferric gluconate (31 33), show evidence of bioactive iron release in vitro and in vivo. Accordingly, evidence for a possible pathogenic link between IV iron administration and cardiovascular disease deserves close examination. There is little debate that IV iron therapy, tissue iron burden, and oxidative stress are causally related. Acute iron administration, whether IV (34,35) or oral (36,37), clearly generates evidence of oxidative stress. The acute effects of IV iron, however, are modest, transient, and related to the degree of elevation of the transferrin saturation (34). Chronic, repeated IV
