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. 2013 Jun;126(6):541.e1-541.e14.
doi: 10.1016/j.amjmed.2012.11.030. Epub 2013 Apr 15.

The comparative short-term effectiveness of iron dosing and formulations in US hemodialysis patients

Abhijit V Kshirsagar  1 , Janet K Freburger, Alan R Ellis, Lily Wang, Wolfgang C Winkelmayer, M Alan Brookhart
Affiliations

The comparative short-term effectiveness of iron dosing and formulations in US hemodialysis patients

Abhijit V Kshirsagar et al. Am J Med. 2013 Jun.

Abstract

Background: Intravenous iron is used widely in hemodialysis, yet there are limited data on the effectiveness of contemporary dosing strategies or formulation type.

Methods: We conducted a retrospective cohort study using data from the clinical database of a large dialysis provider (years 2004-2008) merged with administrative data from the US Renal Data System to compare the effects of intravenous iron use on anemia management. Dosing comparisons were bolus (consecutive doses ≥100 mg exceeding 600 mg during 1 month) versus maintenance (all other iron doses during the month); and high (>200 mg over 1 month) versus low dose (≤200 mg over 1 month). Formulation comparison was administration of ferric gluconate versus iron sucrose over 1 month. Outcomes were hemoglobin, epoetin dose, transferrin saturation, and serum ferritin during 6 weeks of follow-up.

Results: We identified 117,050 patients for the dosing comparison, and 66,207 patients for the formulation comparison. Bolus dosing was associated with higher average adjusted hemoglobin (+0.23 g/dL; 95% confidence interval [CI], 0.21-0.26), transferrin saturation (+3.31%; 95% CI, 2.99-3.63), serum ferritin (+151 μg/L; 95% CI, 134.9-168.7), and lower average epoetin dose (-464 units; 95% CI, -583 to -343) compared with maintenance. Similar trends were observed with high-dose iron versus low-dose. Iron sucrose was associated with higher adjusted average hemoglobin (+0.16 g/dL; 95% CI, 0.12-0.19) versus ferric gluconate.

Conclusions: Strategies favoring large doses of intravenous iron or iron sucrose lead to improved measures of anemia management. These potential benefits should be weighed against risks, which currently remain incompletely characterized.

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Conflict of interest statement

Conflict of Interest: Dr. Brookhart—investigator initiated support from Amgen, and advisory boards for Amgen, Pfizer, and Rockwell Medical. Dr. Winkelmayer—scientific advisory board for Amgen and Fibrinogen

Figures

Figure 1
Figure 1
Study Design
Figure 2
Figure 2
Creation of Study Cohorts
Figure 3
Figure 3
Average hemoglobin by dosing pattern of IV iron (Fully adjusted model).
Figure 4
Figure 4
Average EPO dose by dosing pattern of IV iron (Fully adjusted model).
Figure 5
Figure 5
Average hemoglobin by dosing pattern of IV iron (Fully adjusted model).
Figure 6
Figure 6
Average EPO dose by dosing pattern of IV iron (Fully adjusted model).
Figure 7
Figure 7
Average hemoglobin by formulation of IV iron (Fully adjusted model).
Figure 8
Figure 8
Average EPO dose by formulation of IV iron (Fully adjusted model).
See this image and copyright information in PMC

Comment in

  • Is iron maintenance therapy better than load and hold?
    Rhee CM, Kalantar-Zadeh K. Rhee CM, et al. J Am Soc Nephrol. 2013 Jun;24(7):1028-31. doi: 10.1681/ASN.2013050456. Epub 2013 Jun 20. J Am Soc Nephrol. 2013. PMID: 23787912 Free PMC article. No abstract available.
  • How much intravenous iron is utilized for erythropoiesis?
    Nakanishi T, Hasuike Y, Nagasawa Y, Kuragano T. Nakanishi T, et al. Am J Med. 2013 Nov;126(11):e27. doi: 10.1016/j.amjmed.2013.05.028. Am J Med. 2013. PMID: 24157298 No abstract available.
  • The reply.
    Kshirsagar AV, Brookhart MA. Kshirsagar AV, et al. Am J Med. 2013 Nov;126(11):e29. doi: 10.1016/j.amjmed.2013.07.010. Am J Med. 2013. PMID: 24157299 No abstract available.

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References

    1. Coyne DW, Kaponian T, Suki W, et al. Ferric gluconate is highly efficacious in anemic Hemodialysis patients with high serum ferritin and low transferring saturation: Results of the Dialysis Patients Response to IV Iron with Elevate Ferritin (DRIVE) Study. J Am Soc Nephrol. 2007;18:975–984. - PubMed
    1. Freburger JK, Ng LJ, Bradbury BD, et al. Changing patterns of anemia management in US Hemodialysis patients. Am J Med. 2012;125:906–914. - PubMed
    1. Thakuria M, Ofsthun NJ, Mullon C, Diaz-Buxo JA. Anemia management in patients receiving chronic hemodialysis. Semin Dial. 2011;24:597–602. - PubMed
    1. Yong K, Kairaitis L. Effects of proactive iron and erythropoiesis-stimulating agent protocol implementation on achieving clinical guideline targets for anaemia in a satellite haemodialysis patient cohort. Nephrology (Carlton) 2010;15:288–293. - PubMed
    1. American Regent Laboratories I. Venofer (iron sucrose) package insert. Shirley, NY: 2003.

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