Intravenous iron exposure and mortality in patients on hemodialysis

Developing Evidence to Inform Decisions about Effectiveness (DEcIDE), Network Patient Outcomes in End Stage Renal Disease Study Investigators

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61 Scopus citations


Background and objectives Clinical trials assessing effects of larger cumulative iron exposure with outcomes are lacking, and observational studies have been limited by assessment of short-term exposure only and/or failure to assess cause-specific mortality. The associations between short- and long-term iron exposure on all-cause and cause-specific mortality were examined. Design, setting, participants, & measurements The study included 14,078 United States patients on dialysis initiating dialysis between 2003 and 2008. Intravenous iron dose accumulations over 1-, 3-, and 6-month rolling windows were related to all-cause, cardiovascular, and infection-related mortality in Cox proportional hazards models that used marginal structural modeling to control for time-dependent confounding. Results Patients in the 1-month model cohort (n=14,078) were followed a median of 19 months, during which there were 27.6% all-cause deaths, 13.5% cardiovascular deaths, and 3% infection-related deaths. A reduced risk of all-cause mortality with receipt of.150–350 (hazard ratio, 0.78; 95% confidence interval, 0.64 to 0.95) or.350 mg (hazard ratio, 0.79; 95% confidence interval, 0.62 to 0.99) intravenous iron compared with.0–150 mg over 1 month was observed. There was no relation of 1-month intravenous iron dose with cardiovascular or infection related mortality and no relation of 3- or 6-month cumulative intravenous iron dose with all-cause or cardiovascular mortality. There was a nonstatistically significant increase in infection-related mortality with receipt of.1050mg intravenous iron in 3 months (hazard ratio, 1.69; 95%confidence interval, 0.87 to 3.28) and.2100mg in 6 months (hazard ratio, 1.59; 95% confidence interval, 0.73 to 3.46). Conclusions Among patients on incident dialysis, receipt of #1050 mg intravenous iron in 3 months or 2100 mg in 6 months was not associated with all-cause, cardiovascular, or infection-related mortality. However, nonstatistically significant findings suggested the possibility of infection-related mortality with receipt of.1050 mg in 3 months or.2100 mg in 6 months. Randomized clinical trials are needed to assess the safety of exposure to greater cumulative intravenous iron doses.

Original languageEnglish (US)
Pages (from-to)1930-1939
Number of pages10
JournalClinical Journal of the American Society of Nephrology
Issue number11
StatePublished - 2015

ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation


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