Abstract: SA-PO158

Effects of Intravenous Iron Therapy on the Mortality and Hospitalization in Hemodialysis Patients

Session Information

Category: Nutrition, Inflammation, and Metabolism

  • 1401 Nutrition, Inflammation, Metabolism

Authors

  • Lim, Chun Soo, Seoul National University Boramae Medical Center, Seoul, Korea (the Republic of)
  • Oh, Yun Kyu, Seoul National University Boramae Medical Center, Seoul, Korea (the Republic of)
Background

Iron replacement therapy is inevitable to correct iron deficiency anemia in advanced chronic kidney disease patients. Intravenous (IV) iron therapy has been known as an efficient method to replace iron, especially in patients who are intolerant to oral iron. However, there have been concerns of considerable side effects with IV iron usage including increased risks of infection or cardiovascular disease (CVD). In this study, we compared IV iron usage with oral iron to assess the adverse effects in the prospective cohort of Korean patients.

Methods

We conducted multicenter prospective cohort study using Clinical Research Center for end stage renal disease. We enrolled 1,721 adult patients who were on hemodialysis between 2008 and 2013. Basic patient characteristics, laboratory data, dose of erythropoiesis stimulating agents (ESA) and 3-month iron dose were collected after enrollment. All-cause mortality, death and hospitalization due to infection or CVD were compared and propensity score matching were conducted to exclude the effects of other factors in outcome.

Results

In total 1,721 patients, 505 patients received IV iron therapy and 658 patients received oral iron only. Median IV iron dose during 3 months was 600mg (100 – 9,000 mg). In IV iron usage group, hemoglobin, ferritin, serum iron and transferrin saturation were significantly lower and total iron-binding capacity, ESA dose and erythropoietin resistance index were higher compared to oral iron group. During mean follow-up duration of 743.6±578.4 days, all-cause mortality, death due to infection or CVD and both death and hospitalization due to infection or CVD did not differ between two groups. Even in subgroup analysis of patients with higher IV iron usage (>600 mg/3 months), there were no significant differences in adverse outcomes. However, in subgroup analysis of prevalent patients, IV iron usage group tend to show higher hospitalization and death due to infection and CVD. After propensity score matching, similar trends were observed.

Conclusion

The current clinical usage of IV iron in hemodialysis patients did not increase all-cause mortality or death and hospitalization due to infection or CVD compared to oral iron therapy. A well-designed randomized controlled trial is needed to clarify both short-term and long-term effects of IV iron therapy.