Intravenous Iron Replacement Therapy Improves Cardiovascular Outcomes in Hemodialysis Patients

Abstract

Background/aim: More than half of deaths among hemodialysis patients are due to cardiovascular disease. This study examined whether intravenous administration of ferric carboxymaltose (FCM) has an impact on cardiovascular events in iron-deficient hemodialysis patients.

Patients and methods: We performed a retrospective study concerning patients undergoing hemodialysis in our center from September 2016 to December 2019. We identified those who began FCM therapy (FCM group) during this period and those who did not (control group). We analyzed clinical, echocardiographic and laboratory parameters at the beginning (t0) and after one year (t1), to detect differences between the two groups.

Results: We identified 53 patients for the FCM group and 19 for the control group. Median follow-up was 1 year±3 months for both groups. In the FCM group, we observed a reduction in the doses of erythropoiesis-stimulating agents (ESA) (p<0.001) and a significative difference in cardiovascular events (p<0.01), but no differences in echocardiographic parameters.

Conclusion: Patients who received FCM reached satisfactory values of transferrin saturation and ferritin, presented fewer coronary artery events and cardiovascular events, and could reduce doses of ESA.

Keywords: Anaemia; cardiovascular disease; echocardiography; haemodialysis; iron.

Figure 1. Changes in Hb, sTF and ferritin after one-year observation between the two groups. sTF and ferritin showed a significant increase in the group receiving FCM vs. the control group. Hb: Hemoglobin; sTF: transferrin saturation; FCM: ferric carboxymaltose.

Figure 2. Cardiovascular events in the two groups after one-year observation. Significant results were observed for cardiovascular events (CVE) and coronary artery disease (CA). AF: Atrial fibrillation; CHF: cardiac heart failure; FCM: ferric carboxymaltose.