Abstract: SA-PO806

Impact of Intra-Venous Ferric-Sucrose Hydroxide on Mortality in HD: MEDIAL Iron Cohort ECHO (MICE Study)

Session Information

Category: Dialysis

  • 605 Dialysis: Anemia and Iron Metabolism

Authors

  • Menoyo, Victorio, ECHO, NANTES, France
  • Touam, Malik, Necker Hospital, Paris, France
  • Durand, Pierre-Yves, ECHO, VANNES, France
  • Testa, A., ECHO NANTES, NANTES, France

Group or Team Name

  • MEDIAL STUDY GROUP
Background

Intraveinous iron is the main complement to Erythropoiesis Stimulant Agent (ESA) treatment for HD patients. Ferric Sucrose Hydroxide (HFS) is one of this. Previous retrospective studies have shown the potential toxicity of HSF, and have report increased mortality above some monthly dose. We aimed to study the toxicity of HSF, and to precize its relationship with this markers.

Methods

Medical Iron Cohort ECHO is a multicenter cohort of HD patients coming from 49 HD french centers. All incident patients were included from year 2005 to 2015. Data were retrospectively analyzed. Iron injections, ESA, hemoglobin and other biological data were recorded in a single database : MEDIAL. Statistical analysis used a non-parametric test for exceedances of the Ferritin, TSAT and CRP standards as well as kt/V <1.3. We considered the usual demographics and diabetes. We have defined 4 subgroups according to the dose of HFS: A: <100 mg / month; B: 100-200 mg / month; C: 200-300 mg / month; D: 300-400 mg / month; E:> 400 mg / month. The proportional risk regression survival analysis (Cox model) was performed using the STATISTICA software.

Results

1,370 patients were included. The average follow-up was 41.5 months. 481 deaths occured during the study period. It was a very strong relationship between mortality and HFS dose above 200 mg / month. (P <0.0000) The stratified analysis showed that this relationship was dose-dependent and the effect appears above a dose of 100 mg / month of HFS.
Although there was no significant difference between subgroups A, B, C, there was a trend towards it.
There was no significant relationship between mortality and Ferritin or TSAT blood levels. There was no significant difference between the 5 groups regarding the received ESA dose or hemoglobin.
Gender and diabetes were not linked to mortality, while other independent factors appeared to be significant: age at onset of dialysis, albuminemia, CRP and kt/V <1.3.

Conclusion

This study suggests that intraveinous HFS in HD patients could be toxic, probably for doses considered to be low toxicity to date. Ferritin and TSAT blood levels are not good markers for HSF toxicity. Advanced age at the start of ESRD, undernutrition, inflammatory status, or poor dialysis dose are significant markers linked to mortality. Further prospective studies are required to confirm these results.