Intravenous iron administration strategies and anemia management in hemodialysis patients.

Published

Journal Article

Background: The effect of maintenance intravenous (IV) iron administration on subsequent achievement of anemia management goals and mortality among patients recently initiating hemodialysis is unclear. Methods: 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. Results: 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)]. Conclusions: 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 1, 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

Digital Object Identifier (DOI)

  • 10.1093/ndt/gfw316

Language

  • eng

Conference Location

  • England