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Intravenous iron exposure and mortality in patients on hemodialysis.

Publication ,  Journal Article
Miskulin, DC; Tangri, N; Bandeen-Roche, K; Zhou, J; McDermott, A; Meyer, KB; Ephraim, PL; Michels, WM; Jaar, BG; Crews, DC; Scialla, JJ ...
Published in: Clin J Am Soc Nephrol
November 7, 2014

BACKGROUND AND OBJECTIVES: Clinical trials assessing effects of larger cumulative iron exposure with outcomes are lacking, and observational studies have been limited by assessment of short-term exposure only and/or failure to assess cause-specific mortality. The associations between short- and long-term iron exposure on all-cause and cause-specific mortality were examined. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The study included 14,078 United States patients on dialysis initiating dialysis between 2003 and 2008. Intravenous iron dose accumulations over 1-, 3-, and 6-month rolling windows were related to all-cause, cardiovascular, and infection-related mortality in Cox proportional hazards models that used marginal structural modeling to control for time-dependent confounding. RESULTS: Patients in the 1-month model cohort (n=14,078) were followed a median of 19 months, during which there were 27.6% all-cause deaths, 13.5% cardiovascular deaths, and 3% infection-related deaths. A reduced risk of all-cause mortality with receipt of >150-350 (hazard ratio, 0.78; 95% confidence interval, 0.64 to 0.95) or >350 mg (hazard ratio, 0.79; 95% confidence interval, 0.62 to 0.99) intravenous iron compared with >0-150 mg over 1 month was observed. There was no relation of 1-month intravenous iron dose with cardiovascular or infection-related mortality and no relation of 3- or 6-month cumulative intravenous iron dose with all-cause or cardiovascular mortality. There was a nonstatistically significant increase in infection-related mortality with receipt of >1050 mg intravenous iron in 3 months (hazard ratio, 1.69; 95% confidence interval, 0.87 to 3.28) and >2100 mg in 6 months (hazard ratio, 1.59; 95% confidence interval, 0.73 to 3.46). CONCLUSIONS: Among patients on incident dialysis, receipt of ≤ 1050 mg intravenous iron in 3 months or 2100 mg in 6 months was not associated with all-cause, cardiovascular, or infection-related mortality. However, nonstatistically significant findings suggested the possibility of infection-related mortality with receipt of >1050 mg in 3 months or >2100 mg in 6 months. Randomized clinical trials are needed to assess the safety of exposure to greater cumulative intravenous iron doses.

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Published In

Clin J Am Soc Nephrol

DOI

EISSN

1555-905X

Publication Date

November 7, 2014

Volume

9

Issue

11

Start / End Page

1930 / 1939

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • United States
  • Time Factors
  • Renal Dialysis
  • Proportional Hazards Models
  • Middle Aged
  • Male
  • Kidney Failure, Chronic
  • Iron
  • Infections
 

Citation

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Miskulin, D. C., Tangri, N., Bandeen-Roche, K., Zhou, J., McDermott, A., Meyer, K. B., … Developing Evidence to Inform Decisions about Effectiveness (DEcIDE) Network Patient Outcomes in End Stage Renal Disease Study Investigators, . (2014). Intravenous iron exposure and mortality in patients on hemodialysis. Clin J Am Soc Nephrol, 9(11), 1930–1939. https://doi.org/10.2215/CJN.03370414
Miskulin, Dana C., Navdeep Tangri, Karen Bandeen-Roche, Jing Zhou, Aidan McDermott, Klemens B. Meyer, Patti L. Ephraim, et al. “Intravenous iron exposure and mortality in patients on hemodialysis.Clin J Am Soc Nephrol 9, no. 11 (November 7, 2014): 1930–39. https://doi.org/10.2215/CJN.03370414.
Miskulin DC, Tangri N, Bandeen-Roche K, Zhou J, McDermott A, Meyer KB, et al. Intravenous iron exposure and mortality in patients on hemodialysis. Clin J Am Soc Nephrol. 2014 Nov 7;9(11):1930–9.
Miskulin, Dana C., et al. “Intravenous iron exposure and mortality in patients on hemodialysis.Clin J Am Soc Nephrol, vol. 9, no. 11, Nov. 2014, pp. 1930–39. Pubmed, doi:10.2215/CJN.03370414.
Miskulin DC, Tangri N, Bandeen-Roche K, Zhou J, McDermott A, Meyer KB, Ephraim PL, Michels WM, Jaar BG, Crews DC, Scialla JJ, Sozio SM, Shafi T, Wu AW, Cook C, Boulware LE, Developing Evidence to Inform Decisions about Effectiveness (DEcIDE) Network Patient Outcomes in End Stage Renal Disease Study Investigators. Intravenous iron exposure and mortality in patients on hemodialysis. Clin J Am Soc Nephrol. 2014 Nov 7;9(11):1930–1939.

Published In

Clin J Am Soc Nephrol

DOI

EISSN

1555-905X

Publication Date

November 7, 2014

Volume

9

Issue

11

Start / End Page

1930 / 1939

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • United States
  • Time Factors
  • Renal Dialysis
  • Proportional Hazards Models
  • Middle Aged
  • Male
  • Kidney Failure, Chronic
  • Iron
  • Infections