Abstract: SA-PO796

The Impact of Dose of ESA and Iron on the Risk of Adverse Events in Hemodialysis Patients

Session Information

Category: Dialysis

  • 605 Dialysis: Anemia and Iron Metabolism

Authors

  • Kuragano, Takahiro, Internal Medicine Division of Kidney and Dialysis, Nishinomiya, Japan
  • Nakanishi, Takeshi, Hyogo College of Mediicne, Nishinomiya, Japan
Background

Anemia treatment with higher doses of ESA in patients with maintenance hemodialysis(MHD) might increase the risk of cardiovascular disease(CVD). On the other hand, higher doses of iron might cause iron overload, which can induce oxidative stress and CVD. The effects of the dosage balance of ESA and iron on the adverse events of MHD patients have not been well established.

Methods

This work was a prospective observational multicenter study over a period of 3 years in 1095 patients on MHD. The patients were divided into 4 groups according to the dose of ESA (high ESA (≥3000 IU/week), low ESA) and intravenous iron (high iron (≥15 mg/week), and low iron). Furthermore, in another analysis, the patients were divided into 4 groups according to the dose of ESA and iron storage (high ferritin (≥50 ng/mL), and low ferritin). A time-dependent Cox hazard model was applied to evaluate the association between patient groups and adverse events.

Results

Doses of ESA and iron: There was no significant difference in CVD risk between low ESA/low iron and high ESA/low iron. However, the CVD risks for high ESA/high iron (HR: 2.6, P=0.03) and low ESA/high iron (HR: 3.1, P=0.01) were significantly higher than that for low ESA/low iron. The risk of death for high ESA/high iron was significantly (HR: 2.8, P=0.04) higher than for low ESA/low iron. Dose of ESA according to iron storage: There was no significant difference in CVD risk between low ESA/low ferritin and high ESA/low ferritin. However, the CVD risks for low ESA/high ferritin (HR: 3.3, P=0.01) and high ESA/high ferritin (HR: 3.3, P=0.01) were significantly higher than that for low ESA/low ferritin. The risk of death for high ESA/high ferritin was significantly (HR: 3.1, P=0.01) higher than that for low ESA/low ferritin.

Conclusion

We found that high doses of ESA and iron were significantly associated with higher risks of CVD and death. Regardless of ESA dose, a higher dose of iron was significantly associated with a higher risk of CVD. Interestingly, patients with iron deficiency treated with a high dose of ESA were not necessarily at high risk of CVD. We concluded that a higher dose of iron for improving the responsiveness to ESA did not necessarily attenuate this risk of CVD and death.