Lower ESA Use for Anemia Linked to Maintenance IV Iron
Management strategy also is associated with reduced mortality risk, but not achievement of hemoglobin targets.
Maintenance intravenous (IV) iron administration for managing anemia in hemodialysis patients is associated with decreased use of erythropoiesis-stimulating agents (ESAs) and lower mortality, according to a new study. This management strategy, however, is not associated with achievement of hemoglobin targets.
“Our findings provide evidence that maintenance IV iron administration may represent a beneficial treatment strategy for incident hemodialysis patients, but the findings of this observational study should be confirmed by randomized clinical trials,” the investigators concluded in a paper published online ahead of print in Nephrology Dialysis Transplantation.
The study was conducted by members of the DEcIDE study group at the Welsh Center for Prevention, Epidemiology and Clinical Research at Johns Hopkins Medical Institutions in Baltimore. Wieneke M. Michels, MD, of the University of Amsterdam, The Netherlands, led the study during a postdoctoral fellowship at the Welch Center.
The investigators studied 12,969 adult patients initiating hemodialysis (HD). They defined IV administration strategies over a 12-week period after the first transferrin saturation measurement 60 to 120 days following dialysis initiation. They defined maintenance as IV iron administration of at least 1 dose of IV iron each week, every other week, every 3 weeks, or every 4 weeks during the 12-week period. All other IV iron strategies were considered non-maintenance. Of the 12,969 patients, 4511 received maintenance IV iron and 8458 received non-maintenance IV iron. The outcomes under study were a greater than 25% reduction in mean weekly ESA dose, mortality, and achievement of a hemoglobin level of 10–12 g/dL.
Maintenance IV iron use was associated with a significant 33% increased odds of achieving a greater than 25% reduction in ESA dose and 27% decreased risk of death, Dr Michels' team reported. Maintenance IV iron was not associated with increased odds of achieving a target hemoglobin level of 10–12 g/dL.
The investigators stated that, to their knowledge, their study is the first comparative analysis of IV iron administration strategies on anemia management in incident HD patients.
1. Michels WM, Jaar BG, Ephraim PL, et al. Intravenous iron administration strategies and anemia management in hemodialysis patients. Nephrol Dial Transplant. (2016) doi:10.1093/ndt/gfw316. [Epub ahead of print].