Intravenous iron administration strategies and anemia management in hemodialysis patients.


Journal Article

The effect of maintenance intravenous (IV) iron administration on subsequent achievement of anemia management goals and mortality among patients recently initiating hemodialysis is unclear.We performed an observational cohort study, in adult incident dialysis patients starting on hemodialysis. We defined IV administration strategies over a 12-week period following a patient's initiation of hemodialysis; all those receiving IV iron at regular intervals were considered maintenance, and all others were considered non-maintenance. We used multivariable models adjusting for demographics, clinical and treatment parameters, iron dose, measures of iron stores and pro-infectious and pro-inflammatory parameters to compare these strategies. The outcomes under study were patients' (i) achievement of hemoglobin (Hb) of 10-12 g/dL, (ii) more than 25% reduction in mean weekly erythropoietin stimulating agent (ESA) dose and (iii) mortality, ascertained over a period of 4 weeks following the iron administration period.Maintenance IV iron was administered to 4511 patients and non-maintenance iron to 8458 patients. Maintenance IV iron administration was not associated with a higher likelihood of achieving an Hb between 10 and 12 g/dL {adjusted odds ratio (OR) 1.01 [95% confidence interval (CI) 0.93-1.09]} compared with non-maintenance, but was associated with a higher odds of achieving a reduced ESA dose of 25% or more [OR 1.33 (95% CI 1.18-1.49)] and lower mortality [hazard ratio (HR) 0.73 (95% CI 0.62-0.86)].Maintenance IV iron strategies were associated with reduced ESA utilization and improved early survival but not with the achievement of Hb targets.

Full Text

Duke Authors

Cited Authors

  • Michels, WM; Jaar, BG; Ephraim, PL; Liu, Y; Miskulin, DC; Tangri, N; Crews, DC; Scialla, JJ; Shafi, T; Sozio, SM; Bandeen-Roche, K; Cook, CJ; Meyer, KB; Boulware, LE; DEcIDE Network Patient Outcomes in End Stage Renal Disease Study Investigators,

Published Date

  • January 2017

Published In

Volume / Issue

  • 32 / 1

Start / End Page

  • 173 - 181

PubMed ID

  • 27604984

Pubmed Central ID

  • 27604984

Electronic International Standard Serial Number (EISSN)

  • 1460-2385

International Standard Serial Number (ISSN)

  • 0931-0509

Digital Object Identifier (DOI)

  • 10.1093/ndt/gfw316


  • eng