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Observational Study
. 2017 Jan 1;32(1):173-181.
doi: 10.1093/ndt/gfw316.

Intravenous iron administration strategies and anemia management in hemodialysis patients

Wieneke M Michels  1   2   3 , Bernard G Jaar  3   4   5   6 , Patti L Ephraim  3   6 , Yang Liu  3   4 , Dana C Miskulin  7 , Navdeep Tangri  8 , Deidra C Crews  3   4 , Julia J Scialla  9 , Tariq Shafi  3   4 , Stephen M Sozio  3   4 , Karen Bandeen-Roche  4   10 , Courtney J Cook  2   3 , Klemens B Meyer  7 , L Ebony Boulware  2   3   6   11 ; DEcIDE Network Patient Outcomes in End Stage Renal Disease Study Investigators
Affiliations
Observational Study

Intravenous iron administration strategies and anemia management in hemodialysis patients

Wieneke M Michels et al. Nephrol Dial Transplant. .

Abstract

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.

Keywords: administration strategies; anemia; hemodialysis; iron; mortality.

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Figures

FIGURE 1
FIGURE 1
Timeline of the study, expressing the exposure and follow-up period in relation to dialysis initiation and iron parameter measurements. IV, intravenous; ESA, erythropoietin stimulating agents, TSat, transferrin saturation; Hb, hemoglobin.
FIGURE 2
FIGURE 2
Flow diagram of in- and exclusion of study participants in the maintenance and non-maintenance IV iron administration strategy groups. CI, confidence interval; DCI, Dialysis Clinic Inc.; HD, hemodialysis; PD, peritoneal dialysis; TSat, transferrin saturation; Hb, hemoglobin.
FIGURE 3
FIGURE 3
Differences in hemoglobin levels and mean weekly erythropoietin stimulating agent (ESA) doses before and after the exposure period. The figure represents the difference in means of hemoglobin levels and mean weekly doses corrected for body weight (units/kg).
FIGURE 4
FIGURE 4
Kaplan–Meier curve presenting the cumulative probability of mortality for the maintenance and non-maintenance IV iron administration strategy groups during the follow-up period.
See this image and copyright information in PMC

References

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