Objective  To compare the iron supplementation efficacy and infection safety between iron sucrose and iron polysaccharide in maintenance hemodialysis (MHD) patients, and to construct an infection risk model based on dynamic iron parameters.

Methods  A retrospective analysis was conducted on patients who received MHD treatment at the Hemodialysis Center of Wenzhou People's Hospital from January 2022 to December 2024. Patients were divided into the iron sucrose group and the iron polysaccharide group according to the iron supplement they received. Hemoglobin (Hb), serum iron, transferrin saturation (TSAT), and ferritin (SF) levels were compared between the two groups, and the occurrence of infection was recorded. Multivariate Logistic regression was used to identify the independent risk factors of infection. An infection risk model was constructed, and receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA) were used to evaluate the predictive ability, calibration ability, and net clinical benefit of the predictive model.

Results  A total of 150 patients were included, with 75 in the iron sucrose group and 75 in the iron polysaccharide group. Compared with the iron polysaccharide group, the iron sucrose group showed a higher increase in Hb and TSAT and a lower infection rate (P<0.05). SF>800 ng/mL, TSAT>45%, C-reactive protein>10 mg/L, recent hospitalization, diabetes mellitus, and higher erythropoietin doses were independent risk factors for infection (P<0.05). The established infection model had an area under the ROC curve of 0.728, demonstrating good predictive ability, calibration ability, and net clinical benefit.

Conclusion  In MHD patients, iron sucrose supplementation significantly improves anemia and iron metabolism, with a lower associated infection rate. The infection model based on dynamic iron parameters can be used to guide risk stratification and individualized iron supplementation.

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