Effect of intravenous iron use on hospitalizations in patients undergoing hemodialysis

A comparative effectiveness analysis from the DEcIDE-ESRD study

Navdeep Tangri, Dana C. Miskulin, Jing Zhou, Karen J Bandeen Roche, Wieneke M. Michels, Patti L Ephraim, Aidan McDermott, Deidra Crews, Julia J. Scialla, Stephen M Sozio, Tariq Shafi, Bernard Jaar, Klemens Meyer, Leigh Boulware, Courtney Cook, Josef Coresh, Jeonyong Kim, Yang Liu, Jason Luly, Paul Scheel & 18 others Albert W Wu, Neil Powe, Allan Collins, Robert Foley, David Gilbertson, Haifeng Guo, Brooke Heubner, Charles Herzog, Jiannong Liu, Wendy St Peter, Joseph Nally, Susana Arrigain, Stacey Jolly, Vicky Konig, Xiaobo Liu, Sankar Navaneethan, Jesse Schold, Philip Zager

Research output: Contribution to journalArticle

Abstract

Background Intravenous iron use in hemodialysis patients has greatly increased over the last decade, despite limited studies on the safety of iron. Methods We studied the association of receipt of intravenous iron with hospitalizations in an incident cohort of hemodialysis patients. We examined 9544 patients from Dialysis Clinic, Inc. (DCI). We ascertained intravenous iron use from DCI electronic medical record and USRDS data files, and hospitalizations through Medicare claims. We examined the association between iron exposure accumulated over 1-, 3- or 6-month time windows and incident hospitalizations in the follow-up period using marginal structural models accounting for time-dependent confounders. We performed sensitivity analyses including recurrent events models for multiple hospitalizations and models for combined outcome of hospitalization and death. Results There were 22 347 hospitalizations during a median follow-up of 23 months. Higher cumulative dose of intravenous iron was not associated with all-cause, cardiovascular or infectious hospitalizations [HR 0.97 (95% CI: 0.77-1.22) for all-cause hospitalizations comparing >2100 mg versus 0-900 mg of iron over 6 months]. Findings were similar in models examining the risk of hospitalizations in 1- and 3-month windows [HR 0.88 (95% CI: 0.79-0.99) and HR 0.88 (95% CI: 0.74-1.03), respectively] or the risk of combined outcome of hospitalization and death in the 6-month window [HR 0.98 (95% CI: 0.78-1.23)]. Conclusions Higher cumulative dose of intravenous iron may not be associated with increased risk of hospitalizations in hemodialysis patients. While clinical trials are needed, employing higher iron doses to reduce erythropoiesis-stimulating agents does not appear to increase morbidity in routine clinical care.

Original languageEnglish (US)
Pages (from-to)667-675
Number of pages9
JournalNephrology Dialysis Transplantation
Volume30
Issue number4
DOIs
StatePublished - Apr 1 2015

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Chronic Kidney Failure
Renal Dialysis
Hospitalization
Iron
Dialysis
Hematinics
Electronic Health Records
Information Storage and Retrieval
Structural Models
Medicare
Clinical Trials
Morbidity
Safety

Keywords

  • anemia
  • hemodialysis
  • hospitalizations
  • intravenous iron

ASJC Scopus subject areas

  • Nephrology
  • Transplantation

Cite this

Effect of intravenous iron use on hospitalizations in patients undergoing hemodialysis : A comparative effectiveness analysis from the DEcIDE-ESRD study. / Tangri, Navdeep; Miskulin, Dana C.; Zhou, Jing; Bandeen Roche, Karen J; Michels, Wieneke M.; Ephraim, Patti L; McDermott, Aidan; Crews, Deidra; Scialla, Julia J.; Sozio, Stephen M; Shafi, Tariq; Jaar, Bernard; Meyer, Klemens; Boulware, Leigh; Cook, Courtney; Coresh, Josef; Kim, Jeonyong; Liu, Yang; Luly, Jason; Scheel, Paul; Wu, Albert W; Powe, Neil; Collins, Allan; Foley, Robert; Gilbertson, David; Guo, Haifeng; Heubner, Brooke; Herzog, Charles; Liu, Jiannong; St Peter, Wendy; Nally, Joseph; Arrigain, Susana; Jolly, Stacey; Konig, Vicky; Liu, Xiaobo; Navaneethan, Sankar; Schold, Jesse; Zager, Philip.

In: Nephrology Dialysis Transplantation, Vol. 30, No. 4, 01.04.2015, p. 667-675.

Research output: Contribution to journalArticle

Tangri, N, Miskulin, DC, Zhou, J, Bandeen Roche, KJ, Michels, WM, Ephraim, PL, McDermott, A, Crews, D, Scialla, JJ, Sozio, SM, Shafi, T, Jaar, B, Meyer, K, Boulware, L, Cook, C, Coresh, J, Kim, J, Liu, Y, Luly, J, Scheel, P, Wu, AW, Powe, N, Collins, A, Foley, R, Gilbertson, D, Guo, H, Heubner, B, Herzog, C, Liu, J, St Peter, W, Nally, J, Arrigain, S, Jolly, S, Konig, V, Liu, X, Navaneethan, S, Schold, J & Zager, P 2015, 'Effect of intravenous iron use on hospitalizations in patients undergoing hemodialysis: A comparative effectiveness analysis from the DEcIDE-ESRD study', Nephrology Dialysis Transplantation, vol. 30, no. 4, pp. 667-675. https://doi.org/10.1093/ndt/gfu349
Tangri, Navdeep ; Miskulin, Dana C. ; Zhou, Jing ; Bandeen Roche, Karen J ; Michels, Wieneke M. ; Ephraim, Patti L ; McDermott, Aidan ; Crews, Deidra ; Scialla, Julia J. ; Sozio, Stephen M ; Shafi, Tariq ; Jaar, Bernard ; Meyer, Klemens ; Boulware, Leigh ; Cook, Courtney ; Coresh, Josef ; Kim, Jeonyong ; Liu, Yang ; Luly, Jason ; Scheel, Paul ; Wu, Albert W ; Powe, Neil ; Collins, Allan ; Foley, Robert ; Gilbertson, David ; Guo, Haifeng ; Heubner, Brooke ; Herzog, Charles ; Liu, Jiannong ; St Peter, Wendy ; Nally, Joseph ; Arrigain, Susana ; Jolly, Stacey ; Konig, Vicky ; Liu, Xiaobo ; Navaneethan, Sankar ; Schold, Jesse ; Zager, Philip. / Effect of intravenous iron use on hospitalizations in patients undergoing hemodialysis : A comparative effectiveness analysis from the DEcIDE-ESRD study. In: Nephrology Dialysis Transplantation. 2015 ; Vol. 30, No. 4. pp. 667-675.
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abstract = "Background Intravenous iron use in hemodialysis patients has greatly increased over the last decade, despite limited studies on the safety of iron. Methods We studied the association of receipt of intravenous iron with hospitalizations in an incident cohort of hemodialysis patients. We examined 9544 patients from Dialysis Clinic, Inc. (DCI). We ascertained intravenous iron use from DCI electronic medical record and USRDS data files, and hospitalizations through Medicare claims. We examined the association between iron exposure accumulated over 1-, 3- or 6-month time windows and incident hospitalizations in the follow-up period using marginal structural models accounting for time-dependent confounders. We performed sensitivity analyses including recurrent events models for multiple hospitalizations and models for combined outcome of hospitalization and death. Results There were 22 347 hospitalizations during a median follow-up of 23 months. Higher cumulative dose of intravenous iron was not associated with all-cause, cardiovascular or infectious hospitalizations [HR 0.97 (95{\%} CI: 0.77-1.22) for all-cause hospitalizations comparing >2100 mg versus 0-900 mg of iron over 6 months]. Findings were similar in models examining the risk of hospitalizations in 1- and 3-month windows [HR 0.88 (95{\%} CI: 0.79-0.99) and HR 0.88 (95{\%} CI: 0.74-1.03), respectively] or the risk of combined outcome of hospitalization and death in the 6-month window [HR 0.98 (95{\%} CI: 0.78-1.23)]. Conclusions Higher cumulative dose of intravenous iron may not be associated with increased risk of hospitalizations in hemodialysis patients. While clinical trials are needed, employing higher iron doses to reduce erythropoiesis-stimulating agents does not appear to increase morbidity in routine clinical care.",
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T1 - Effect of intravenous iron use on hospitalizations in patients undergoing hemodialysis

T2 - A comparative effectiveness analysis from the DEcIDE-ESRD study

AU - Tangri, Navdeep

AU - Miskulin, Dana C.

AU - Zhou, Jing

AU - Bandeen Roche, Karen J

AU - Michels, Wieneke M.

AU - Ephraim, Patti L

AU - McDermott, Aidan

AU - Crews, Deidra

AU - Scialla, Julia J.

AU - Sozio, Stephen M

AU - Shafi, Tariq

AU - Jaar, Bernard

AU - Meyer, Klemens

AU - Boulware, Leigh

AU - Cook, Courtney

AU - Coresh, Josef

AU - Kim, Jeonyong

AU - Liu, Yang

AU - Luly, Jason

AU - Scheel, Paul

AU - Wu, Albert W

AU - Powe, Neil

AU - Collins, Allan

AU - Foley, Robert

AU - Gilbertson, David

AU - Guo, Haifeng

AU - Heubner, Brooke

AU - Herzog, Charles

AU - Liu, Jiannong

AU - St Peter, Wendy

AU - Nally, Joseph

AU - Arrigain, Susana

AU - Jolly, Stacey

AU - Konig, Vicky

AU - Liu, Xiaobo

AU - Navaneethan, Sankar

AU - Schold, Jesse

AU - Zager, Philip

PY - 2015/4/1

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N2 - Background Intravenous iron use in hemodialysis patients has greatly increased over the last decade, despite limited studies on the safety of iron. Methods We studied the association of receipt of intravenous iron with hospitalizations in an incident cohort of hemodialysis patients. We examined 9544 patients from Dialysis Clinic, Inc. (DCI). We ascertained intravenous iron use from DCI electronic medical record and USRDS data files, and hospitalizations through Medicare claims. We examined the association between iron exposure accumulated over 1-, 3- or 6-month time windows and incident hospitalizations in the follow-up period using marginal structural models accounting for time-dependent confounders. We performed sensitivity analyses including recurrent events models for multiple hospitalizations and models for combined outcome of hospitalization and death. Results There were 22 347 hospitalizations during a median follow-up of 23 months. Higher cumulative dose of intravenous iron was not associated with all-cause, cardiovascular or infectious hospitalizations [HR 0.97 (95% CI: 0.77-1.22) for all-cause hospitalizations comparing >2100 mg versus 0-900 mg of iron over 6 months]. Findings were similar in models examining the risk of hospitalizations in 1- and 3-month windows [HR 0.88 (95% CI: 0.79-0.99) and HR 0.88 (95% CI: 0.74-1.03), respectively] or the risk of combined outcome of hospitalization and death in the 6-month window [HR 0.98 (95% CI: 0.78-1.23)]. Conclusions Higher cumulative dose of intravenous iron may not be associated with increased risk of hospitalizations in hemodialysis patients. While clinical trials are needed, employing higher iron doses to reduce erythropoiesis-stimulating agents does not appear to increase morbidity in routine clinical care.

AB - Background Intravenous iron use in hemodialysis patients has greatly increased over the last decade, despite limited studies on the safety of iron. Methods We studied the association of receipt of intravenous iron with hospitalizations in an incident cohort of hemodialysis patients. We examined 9544 patients from Dialysis Clinic, Inc. (DCI). We ascertained intravenous iron use from DCI electronic medical record and USRDS data files, and hospitalizations through Medicare claims. We examined the association between iron exposure accumulated over 1-, 3- or 6-month time windows and incident hospitalizations in the follow-up period using marginal structural models accounting for time-dependent confounders. We performed sensitivity analyses including recurrent events models for multiple hospitalizations and models for combined outcome of hospitalization and death. Results There were 22 347 hospitalizations during a median follow-up of 23 months. Higher cumulative dose of intravenous iron was not associated with all-cause, cardiovascular or infectious hospitalizations [HR 0.97 (95% CI: 0.77-1.22) for all-cause hospitalizations comparing >2100 mg versus 0-900 mg of iron over 6 months]. Findings were similar in models examining the risk of hospitalizations in 1- and 3-month windows [HR 0.88 (95% CI: 0.79-0.99) and HR 0.88 (95% CI: 0.74-1.03), respectively] or the risk of combined outcome of hospitalization and death in the 6-month window [HR 0.98 (95% CI: 0.78-1.23)]. Conclusions Higher cumulative dose of intravenous iron may not be associated with increased risk of hospitalizations in hemodialysis patients. While clinical trials are needed, employing higher iron doses to reduce erythropoiesis-stimulating agents does not appear to increase morbidity in routine clinical care.

KW - anemia

KW - hemodialysis

KW - hospitalizations

KW - intravenous iron

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