Intravenous iron administration strategies and anemia management in hemodialysis patients

Wieneke M. Michels, Bernard Jaar, Patti L Ephraim, Yang Liu, Dana C. Miskulin, Navdeep Tangri, Deidra Crews, Julia J. Scialla, Tariq Shafi, Stephen M Sozio, Karen J Bandeen Roche, Courtney J. Cook, Klemens B. Meyer, Leigh Boulware

Research output: Contribution to journalArticle

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 proinfectious 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 fadjusted odds ratio (OR) 1.01 [95% confidence interval (CI) 0.93-1.09]g 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.

Original languageEnglish (US)
Pages (from-to)173-181
Number of pages9
JournalNephrology Dialysis Transplantation
Volume32
Issue number1
DOIs
StatePublished - 2017

Fingerprint

Intravenous Administration
Renal Dialysis
Anemia
Iron
Maintenance
Erythropoietin
Hemoglobins
Confidence Intervals
Mortality
Odds Ratio
Observational Studies
Dialysis
Cohort Studies
Demography
Outcome Assessment (Health Care)
Survival

Keywords

  • Administration strategies
  • Anemia
  • Hemodialysis
  • Iron
  • Mortality

ASJC Scopus subject areas

  • Nephrology
  • Transplantation

Cite this

Intravenous iron administration strategies and anemia management in hemodialysis patients. / Michels, Wieneke M.; Jaar, Bernard; Ephraim, Patti L; Liu, Yang; Miskulin, Dana C.; Tangri, Navdeep; Crews, Deidra; Scialla, Julia J.; Shafi, Tariq; Sozio, Stephen M; Bandeen Roche, Karen J; Cook, Courtney J.; Meyer, Klemens B.; Boulware, Leigh.

In: Nephrology Dialysis Transplantation, Vol. 32, No. 1, 2017, p. 173-181.

Research output: Contribution to journalArticle

Michels, Wieneke M. ; Jaar, Bernard ; Ephraim, Patti L ; Liu, Yang ; Miskulin, Dana C. ; Tangri, Navdeep ; Crews, Deidra ; Scialla, Julia J. ; Shafi, Tariq ; Sozio, Stephen M ; Bandeen Roche, Karen J ; Cook, Courtney J. ; Meyer, Klemens B. ; Boulware, Leigh. / Intravenous iron administration strategies and anemia management in hemodialysis patients. In: Nephrology Dialysis Transplantation. 2017 ; Vol. 32, No. 1. pp. 173-181.
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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 proinfectious 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 fadjusted odds ratio (OR) 1.01 [95{\%} confidence interval (CI) 0.93-1.09]g 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.",
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T1 - Intravenous iron administration strategies and anemia management in hemodialysis patients

AU - Michels, Wieneke M.

AU - Jaar, Bernard

AU - Ephraim, Patti L

AU - Liu, Yang

AU - Miskulin, Dana C.

AU - Tangri, Navdeep

AU - Crews, Deidra

AU - Scialla, Julia J.

AU - Shafi, Tariq

AU - Sozio, Stephen M

AU - Bandeen Roche, Karen J

AU - Cook, Courtney J.

AU - Meyer, Klemens B.

AU - Boulware, Leigh

PY - 2017

Y1 - 2017

N2 - 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 proinfectious 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 fadjusted odds ratio (OR) 1.01 [95% confidence interval (CI) 0.93-1.09]g 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.

AB - 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 proinfectious 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 fadjusted odds ratio (OR) 1.01 [95% confidence interval (CI) 0.93-1.09]g 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.

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KW - Anemia

KW - Hemodialysis

KW - Iron

KW - Mortality

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DO - 10.1093/ndt/gfw316

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