Effect of intravenous iron use on hospitalizations in patients undergoing hemodialysis: A comparative effectiveness analysis from the DEcIDE-ESRD study

Navdeep Tangri, Dana C. Miskulin, Jing Zhou, Karen Bandeen-Roche, Wieneke M. Michels, Patti L. Ephraim, Aidan McDermott, Deidra C. Crews, Julia J. Scialla, Stephen M. Sozio, Tariq Shafi, Bernard G. Jaar, Klemens Meyer, L. Ebony Boulware, Courtney Cook, Josef Coresh, Jeonyong Kim, Yang Liu, Jason Luly, Paul ScheelAlbert Wu, Neil Powe, Allan Collins, Robert Foley, David Gilbertson, Haifeng Guo, Brooke Heubner, Charles Herzog, Jiannong Liu, Wendy St Peter, Joseph Nally, Susana Arrigain, Stacey Jolly, Vicky Konig, Xiaobo Liu, Sankar Navaneethan, Jesse Schold, Philip Zager

Research output: Contribution to journalArticlepeer-review

32 Scopus citations


Background Intravenous iron use in hemodialysis patients has greatly increased over the last decade, despite limited studies on the safety of iron. Methods We studied the association of receipt of intravenous iron with hospitalizations in an incident cohort of hemodialysis patients. We examined 9544 patients from Dialysis Clinic, Inc. (DCI). We ascertained intravenous iron use from DCI electronic medical record and USRDS data files, and hospitalizations through Medicare claims. We examined the association between iron exposure accumulated over 1-, 3- or 6-month time windows and incident hospitalizations in the follow-up period using marginal structural models accounting for time-dependent confounders. We performed sensitivity analyses including recurrent events models for multiple hospitalizations and models for combined outcome of hospitalization and death. Results There were 22 347 hospitalizations during a median follow-up of 23 months. Higher cumulative dose of intravenous iron was not associated with all-cause, cardiovascular or infectious hospitalizations [HR 0.97 (95% CI: 0.77-1.22) for all-cause hospitalizations comparing >2100 mg versus 0-900 mg of iron over 6 months]. Findings were similar in models examining the risk of hospitalizations in 1- and 3-month windows [HR 0.88 (95% CI: 0.79-0.99) and HR 0.88 (95% CI: 0.74-1.03), respectively] or the risk of combined outcome of hospitalization and death in the 6-month window [HR 0.98 (95% CI: 0.78-1.23)]. Conclusions Higher cumulative dose of intravenous iron may not be associated with increased risk of hospitalizations in hemodialysis patients. While clinical trials are needed, employing higher iron doses to reduce erythropoiesis-stimulating agents does not appear to increase morbidity in routine clinical care.

Original languageEnglish (US)
Pages (from-to)667-675
Number of pages9
JournalNephrology Dialysis Transplantation
Issue number4
StatePublished - Apr 1 2015


  • anemia
  • hemodialysis
  • hospitalizations
  • intravenous iron

ASJC Scopus subject areas

  • Nephrology
  • Transplantation


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