Higher-dose IV iron confers greater cardiovascular benefit in patients on dialysis: Study
UK: The use of higher-dose IV iron in patients on hemodialysis significantly lowers the risk of heart failure hospitalization, finds a recent study in the Journal of the American Society of Nephrology. The study was a prespecified Secondary Analysis of the PIVOTAL Trial.
According to the study, the high-dose and low-dose IV iron groups showed similar infection rates. The risk of first cardiovascular events was strongly associated with a recent infection.
"Given the potential cardiovascular benefits of higher-dose IV iron seen in the PIVOTAL trial, our analysis provided reassurance for the administration of higher doses of IV iron than given currently in many units worldwide," wrote the authors.
Previous studies have raised concerns about an increased risk of infections in patients on hemodialysis administered with intravenous (IV) iron. The Proactive IV Iron Therapy in Haemodialysis Patients (PIVOTAL) trial randomized 2141 patients undergoing maintenance hemodialysis for ESKD to a high-dose or a low-dose IV iron regimen, with a primary composite outcome of all-cause death, heart attack, stroke, or hospitalization for heart failure.
Iain C. Macdougall, Department of Renal Medicine, King's College Hospital, London, United Kingdom, and colleagues compared infection rates between the two groups in this prespecified secondary analysis.
Secondary end points included any infection, hospitalization for infection, and death from infection; cumulative event rates were calculated for these end points. The researchers also interrogated the interaction between iron dose and vascular access (fistula versus catheter).
Key findings of the study include:
- There was no significant difference between the high-dose IV iron group compared with the lose-dose group in event rates for all infections (46.5% versus 45.5%, respectively, which represented incidences of 63.3 versus 69.4 per 100 patient years, respectively); rates of hospitalization for infection (29.6% versus 29.3%, respectively) also did not differ.
- There was a significant association between risk of a first cardiovascular event and any infection in the previous 30 days.
- Compared with patients undergoing dialysis with an arteriovenous fistula, those doing so via a catheter had a higher incidence of having any infection, hospitalization for infection, or fatal infection, but IV iron dosing had no effect on these outcomes.
"Given the potential cardiovascular benefits seen in the PIVOTAL trial, this analysis provides further support for administering higher doses of intravenous iron than are currently given in many units worldwide," concluded the authors.
Reference:
The study titled, "Intravenous Iron Dosing and Infection Risk in Patients on Hemodialysis: A Prespecified Secondary Analysis of the PIVOTAL Trial," is published in the Journal of the American Society of Nephrology.
DOI: https://jasn.asnjournals.org/content/31/5/1118.long
