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Abstract: TH-PO683

Association of Iron Replacement Therapy With Kidney Failure and Mortality in Patients With CKD

Session Information

  • Anemia and Iron Metabolism
    November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
    Abstract Time: 10:00 AM - 12:00 PM

Category: Anemia and Iron Metabolism

  • 200 Anemia and Iron Metabolism

Authors

  • Paul, Shejuti, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Shrestha, Prabin, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Sumida, Keiichi, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Thomas, Fridtjof, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Surbhi, Satya, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Naser, Abu Mohd, The University of Memphis, Memphis, Tennessee, United States
  • Streja, Elani, University of California Irvine, Irvine, California, United States
  • Rhee, Connie, University of California Irvine, Irvine, California, United States
  • Kalantar-Zadeh, Kamyar, University of California Irvine, Irvine, California, United States
  • Kovesdy, Csaba P., The University of Tennessee Health Science Center, Memphis, Tennessee, United States
Background

The long term safety of iron replacement therapy (IRT) in patients with chronic kidney disease (CKD) remains unclear. We investigated the association of IRT with the incidence of end stage kidney disease (ESKD) and all-cause mortality in patients with pre-existing CKD.

Methods

In a national cohort of US Veterans we identified 26,315 incident new users of IRT with eGFR <60 ml/min/1.73m2 and a comparable group of 43,783 patients who did not receive IRT. We used clinical trial emulation methods including propensity score (PS) matching to examine the association of IRT vs no IRT with ESKD and mortality in competing risk regressions and in Cox models, respectively.

Results

In the PS matched cohort 14,429 patients received IRT (95% exclusively oral iron) and 14,429 received no IRT. Baseline characteristics were well matched between the two groups; the overall mean (SD) age was 74±10 years, 97% were male, 77% were white, and the baseline eGFR, hemoglobin, and ferritin levels were 45±12 ml/min/1.73m2, 11.5±1.6 g/dL, and 97 (25th-75th pctl: 39-223) µg/L. There were 1,163 cases of incident ESKD (event rate 15/1000PY; 95%CI 14-16) and 18,191 deaths (188/1000PY; 95% CI 185-191) over a median follow-up of 1.7 and 2.4 years, respectively. IRT was not associated with higher risk of ESKD (subhazard ratio and 95% CI: 1.00, 0.89-1.12, p=0.97) or incident death (hazard ratio and 95% CI 0.98, 0.95-1.01, p=0.22) (Table).

Conclusion

In this large national cohort of patients with CKD, IRT (consisting mainly of oral iron replacement) was not associated with higher risk of ESKD or mortality. Notwithstanding these findings, the long term safety of IRT should be tested in clinical trials.

Association of Iron Replacement Therapy with ESKD and All-Cause Mortality
 ESKDAll-cause death
Event rate per 1000PY (95%CI)Subhazard ratio (95%CI)P valueEvent rate per 1000PY (95%CI)Hazard ratio (95%CI)P value
No Iron treatment (N=14,429)15.0 (13.8, 16.2)Reference0.97190 (186, 194)Reference0.22
Iron treatment (N=14,429)14.7 (13.6, 16.0)1.00 (0.89, 1.12)186 (183, 190)0.98 (0.95, 1.01)

Funding

  • Veterans Affairs Support