Iron supplementation in hemodialysis patients with cancer does not increase mortality risk: Study

A recent retrospective, observational study highlighted the iron and erythropoiesis-stimulating agent (ESA) management in hemodialysis (HD) patients diagnosed with cancer. The crucial findings were presented at the 61st European Renal Association Congress which elucidated the frequent occurrence of anemia and iron deficiencies in this patient population and examines the impact of iron and ESA on mortality rates.

This study included HD patients diagnosed with cancer from September 2009 to March 2021 to understand the relationship between iron status and mortality risk. It focused on patients who began HD prior to their cancer diagnosis. Demographic information, lab tests, iron status and the cumulative doses of iron and ESA were collected quarterly that spanned from one year before the cancer diagnosis to one year after.

Out of the 79 patients included in the study, the median age was 72 years with women constituting for 30.4% of the participants. The patients had been on dialysis for a median of 3 years before their cancer diagnosis. The most common cancers observed were prostate (14%), colorectal (13%), bronchopulmonary (11%), urothelial (10%) and skin (10%). Also, 18% of patients had lymph node involvement and 16% had metastasis.

Baseline hemoglobin levels were recorded at a median of 10.4 g/dL and ferritin levels at 412 ng/mL. The median cumulative quarterly dose of iron was 600 mg while ESA was administered at a median dose of 71 UI/kg/week. Following the cancer diagnosis, the iron doses remained relatively stable, but, the ESA doses increased significantly after six months with the median reaching 134 UI/kg/week. Hemoglobin levels remained between 10 and 12 g/dL and ferritin levels showed a moderate rise in the first six months before stabilizing.

The study revealed a high mortality rate of 47.4% within 12 months of follow-up. Age, atrial fibrillation, lymphatic invasion, metastatic invasion and the need for multiple antitumor treatments were identified as independent mortality risk factors. An increased cumulative dose of ESA in the year preceding the cancer diagnosis was associated with higher mortality with a hazard ratio (HR) of 1.41. This association persisted in multivariate analyses (HR 1.37) despite the lower significance in the year following the diagnosis.

The study concluded that while iron administration did not correlate with an increased risk of mortality by potentially allowing for higher doses if necessary, the safety of increasing ESA doses remains uncertain. These findings suggest that while iron dosing can be managed without additional risk, caution is required with ESA supplementation in HD patients with cancer.

Source:

Michon-Colin A, Lombardi Y, Seret G, Lavainne F, Testa A, Ayari H, Rostoker G, Urena Torres PA, Touzot M. Impact of iron and erythropoiesis-stimulating agent (ESA) dose mortality of hemodialysis (HD) patients with cancer. Presented at the 61st European Renal Association Congress. Stockholm, Sweden. May 23-26, 2024