Intravenous iron administration strategies and anemia management in hemodialysis patients

Nephrol Dial Transplant. 2017 Jan 1;32(1):173-181. doi: 10.1093/ndt/gfw316.


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 pro-infectious 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 {adjusted odds ratio (OR) 1.01 [95% confidence interval (CI) 0.93-1.09]} 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.

Keywords: administration strategies; anemia; hemodialysis; iron; mortality.

Publication types

  • Observational Study

MeSH terms

  • Administration, Intravenous
  • Anemia / drug therapy*
  • Cohort Studies
  • Disease Management
  • Female
  • Hemoglobins / analysis
  • Humans
  • Iron / therapeutic use*
  • Male
  • Middle Aged
  • Renal Dialysis*
  • Trace Elements / therapeutic use*


  • Hemoglobins
  • Trace Elements
  • Iron