Abstract: TH-PO681
Association of Iron Therapy With Incidence of 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
- Shrestha, Prabin, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
- Paul, Shejuti, 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
Iron replacement therapy (IRT) is effective in treating iron deficiency, but there are concerns about its effects on kidney function due to the impact of oral iron on the gut microbiome and to the oxidative stress caused by intravenous iron. We aimed to investigate the association of IRT with the incidence of new onset chronic kidney disease.
Methods
We identified 210,209 patients with normal eGFR and no albuminuria (N=51,448 on IRT and N=158,761 not on IRT) from 2004-2018 in a large national cohort of US Veterans. Of the patients receiving IRT, 48,946 (95%) received oral iron only, 63 (0.1%) received intravenous iron only, and 2,439 (4.7%) received both modalities. We used clinical trial emulation methods including propensity score (PS) matching to examine the association of IRT with the incidence of eGFR <60 ml/min/1.73m2 and with incident urine albumin creatinine ratio (UACR) >30 mg/gm (both defined as two values at least 90 days apart) using competing risk regression.
Results
In the PS matched cohort of 64,446 patients (32,223 on IRT and 32,223 not on IRT) characteristics were well matched. The overall mean (SD) age was 66±13 years, 92% were male, 74% were white, and the baseline eGFR, hemoglobin and ferritin levels were 86±16 ml/min/1.73m2, 12±1.6 g/dL and 76 (25th-75th pctl 26-188) µg/L, respectively. There were 10,078 cases of incident eGFR <60 (event rate 37/1000PY; 95% CI 37-38) and 7,632 cases of incident albuminuria (28/1000PY; 95% CI 27-28) over a median follow up of 3.0 years. IRT was associated with a higher risk of incident eGFR <60 (subhazard ratio, 1.23; 95% CI 1.19-1.28) and a higher risk of albuminuria (1.12; 1.07-1.18). (Table)
Conclusion
In this large national cohort of patients with normal kidney function, IRT was associated with modestly higher risks of incident CKD and albuminuria.
Association of Iron Replacement Therapy with Incidence of CKD
| Incident eGFR <60 ml/min/1.73m2 | Incident UACR >30 mg/gm | |||||
| Event rate per 1000PY (95%CI) | Subhazard ratio (95%CI) | P value | Event rate per 1000PY (95%CI) | Hazard ratio (95%CI) | P value | |
| No Iron therapy (N=32,223) | 34 (33,35) | Reference | <0.001 | 26 (25, 27) | Reference | <0.001 |
| Iron therapy (N=32,223) | 41 (40,42) | 1.23 (1.19, 1.28) | 29 (28, 30) | 1.12 (1.07, 1.18) | ||
Funding
- Veterans Affairs Support