Heart Failure Hospitalization in Adults Receiving Hemodialysis and the Effect of Intravenous Iron Therapy
- PMID: 34119470
- DOI: 10.1016/j.jchf.2021.04.005
Heart Failure Hospitalization in Adults Receiving Hemodialysis and the Effect of Intravenous Iron Therapy
Abstract
Objectives: This study sought to examine the effect of intravenous iron on heart failure events in hemodialysis patients.
Background: Heart failure is a common and deadly complication in patients receiving hemodialysis and is difficult to diagnose and treat.
Methods: The study analyzed heart failure events in the PIVOTAL (Proactive IV Iron Therapy in Hemodialysis Patients) trial, which compared intravenous iron administered proactively in a high-dose regimen with a low-dose regimen administered reactively. Heart failure hospitalization was an adjudicated outcome, a component of the primary composite outcome, and a prespecified secondary endpoint in the trial.
Results: Overall, 2,141 participants were followed for a median of 2.1 years. A first fatal or nonfatal heart failure event occurred in 51 (4.7%) of 1,093 patients in the high-dose iron group and in 70 (6.7%) of 1,048 patients in the low-dose group (HR: 0.66; 95% CI: 0.46-0.94; P = 0.023). There was a total of 63 heart failure events (including first and recurrent events) in the high-dose iron group and 98 in the low-dose group, giving a rate ratio of 0.59 (95% CI: 0.40-0.87; P = 0.0084). Most patients presented with pulmonary edema and were mainly treated by mechanical removal of fluid. History of heart failure and diabetes were independent predictors of a heart failure event.
Conclusions: Compared with a lower-dose regimen, high-dose intravenous iron decreased the occurrence of first and recurrent heart failure events in patients undergoing hemodialysis, with large relative and absolute risk reductions. (UK Multicentre Open-label Randomised Controlled Trial Of IV Iron Therapy In Incident Haemodialysis Patients; 2013-002267-25).
Keywords: anemia; dialysis; heart failure; iron; kidney disease.
Copyright © 2021. Published by Elsevier Inc.
Conflict of interest statement
Funding Support and Author Disclosures This work was supported by Kidney Research UK, which was supported by an unrestricted grant from Vifor Fresenius Medical Care Renal Pharma. Drs. Petrie and McMurray are supported by British Heart Foundation Centre of Research Excellence Grant RE/18/6/34217. The supporter/ funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication. Dr Jhund has received consulting fees from Novartis; advisory board fees from Novartis and Cytokinetics; lecture fees from Novartis; and grant support from Boehringer Ingelheim. Dr Petrie has received lecture fees from AstraZeneca, Novartis, Eli Lilly, and Novo Nordisk; grant support from Boehringer Ingelheim; advisory board fees from Boehringer Ingelheim, Novo Nordisk, and Napp Pharmaceuticals; and fees for serving on an endpoint committee from Boehringer Ingelheim, Novo Nordisk, Takeda Pharmaceutical, and Bayer. Dr Anker has received receiving fees for serving on steering committees for Vifor, Bayer, Boehringer Ingelheim, Novartis, and Servier; and grant support from Abbott Vascular. Dr Bhandari has received lecture fees from Vifor Pharma and Pharmacosmos. Dr Kalra has received grants from Vifor Fresenius; and personal fees and nonfinancial support from Vifor Fresenius and Pharmacosmos. Dr Wheeler has received personal fees from AstraZeneca, Akebia, Boehringer Ingelheim, Janssen, Napp, Vifor Fresenius, and Amgen. Dr Ford has received grant support from Kidney Research UK, Vifor Pharma and Pharmacosmos. Dr McMurray has received fees (all fees listed paid to Glasgow University) for serving on a steering committee from Bayer, Cardiorentis, Amgen, Oxford University–Bayer, AbbVie, DalCor Pharmaceuticals, Novartis, Bristol Myers Squibb, Vifor Pharma–Fresenius; fees for serving on an endpoint committee from Cardiorentis; travel support from Cardiorentis, Amgen, Oxford University–Bayer, Theracos, AbbVie, Novartis, GlaxoSmithKline, Vifor Pharma–Fresenius; fees for serving as principal investigator of a trial from Theracos; fees for serving on a data and safety monitoring committee from Pfizer and Merck; fees for serving on an executive committee from Novartis; fees for serving as co-principal investigator of a trial from Novartis and GlaxoSmithKline; advisory board fees from Novartis; and fees for serving on an endpoint adjudication committee from Vifor Pharma–Fresenius. Dr Macdougall has received grants from Kidney Research UK, Akebia, Bayer, and Astellas; personal fees from AMAG, FibroGen, Pharmacosmos, and Vifor Pharma; and grants and personal fees from GlaxoSmithKline. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
