Iron replacement
therapy is necessary for
anemia treatment in patients with advanced
chronic kidney disease. Intravenous (IV)
iron therapy is an efficient method for
iron replacement. However, there are concerns regarding its considerable side effects, including increased risks of
infection or major adverse cardiovascular events (
MACE). This is a longitudinal study from a multicenter prospective cohort study conducted in the Korean
end-stage renal disease population. All-cause mortality, death due to
infection or
MACE, hospitalization due to
infection or
MACE, and all adverse event of death or hospitalization due to
infection or
MACE were compared according to the
iron replacement methods during the first 3 months of enrollment. Among 1,680
hemodialysis patients, 29.3% of patients received IV
iron therapy, and 38% of patients received oral
iron therapy. During the median 632 days follow-up, all-cause mortality, mortality or hospitalization due to
infection or
MACE, and all adverse events did not differ among
iron replacement groups. There were significant differences related to the risk of all adverse events among
iron replacement
therapies in the log-rank test and univariate Cox regression analysis only in the prevalent dialysis patients; however, the significance was lost in multivariate Cox regression analysis. Similar results were observed in the 1-year short-term outcome analysis. High-dose IV
iron did not increase adverse outcomes. All-cause mortality or all adverse events due to
infection or
MACE were not higher with the current clinical regimen of IV
iron replacement
therapy than with oral or no
iron therapy in Korean
hemodialysis patients.