High ESA and Iron Doses Up CVD, Death Risk in Hemodialysis Patients

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High doses of iron are associated with a significantly higher risk of cardiovascular disease, regardless of the dose of erythropoiesis-stimulating agent.
High doses of iron are associated with a significantly higher risk of cardiovascular disease, regardless of the dose of erythropoiesis-stimulating agent.

High doses of an erythropoiesis-stimulating agent (ESA) and iron are associated with significantly higher risks for cardiovascular disease (CVD) and death among patients on hemodialysis, researchers reported at the American Society of Nephrology's Kidney Week 2017 conference in New Orleans.

In addition, higher doses of iron are associated with a significantly higher risk of CVD, regardless of ESA dose.

Takahiro Kuragano, MD, and Takeshi Nakanishi, MD, of Hyogo College of Medicine in Nishinomiya, Japan, conducted a prospective, observational study of 1095 patients on maintenance hemodialysis. They divided patients into 4 groups according to ESA and iron dose: high ESA (3000 IU/week or more)/high iron (15 mg/week or higher); high ESA/low iron; low ESA/high iron; and low ESA/low iron.

The investigators found no significant difference in CVD risk between low ESA/low iron and high ESA/low iron.  High ESA/high iron and low ESA/high iron, however, were associated with a significant 2.6 times and 3.1 times higher risk of CVD, respectively, compared with low ESA/low iron. High ESA/high iron was associated with a significant 2.8 times higher risk of death compared with low ESA/low iron.

Drs Kuragano and Nakanishi also looked at ESA dose according to iron storage. They found no significant difference in CVD risk between low ESA/low ferritin and high ESA/low ferritin, but low ESA/high ferritin and high ESA/high ferritin both were associated with a significant 3.3 times higher risk of CVD compared with low ESA/low ferritin. High ESA/high ferritin was associated with a significant 3.1 times higher risk of death compared with low ESA/low ferritin.

“Interestingly, patients with iron deficiency treated with a high dose of ESA were not necessarily at high risk of CVD,” the investigators concluded in their study abstract. “We concluded that a higher dose of iron for improving the responsiveness to ESA did not necessarily attenuate this risk of CVD and death.”

Reference

Kuragano T, Takeshi N. The impact of dose of ESA and iron on the risk of adverse events in hemodialysis patients. Data presented at the American Society of Nephrology's Kidney Week 2017 conference. Abstract SA-PO796.

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