ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005


The Latest on X

Kidney Week

Please note that you are viewing an archived section from 2022 and some content may be unavailable. To unlock all content for 2022, please visit the archives.

Abstract: SA-PO364

Associations of Iron Sucrose and Intradialytic Blood Pressure

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • Singh, Anika T., Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Yen, Timothy E., Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Sarvode Mothi, Suraj, St Jude Children's Research Hospital, Memphis, Tennessee, United States
  • Waikar, Sushrut S., Boston Medical Center, Boston, Massachusetts, United States
  • McCausland, Finnian R., Brigham and Women's Hospital, Boston, Massachusetts, United States

Intradialytic hypotension (IDH) and intra-HD hypertension (IDHyper) are associated with higher morbidity and mortality in hemodialysis (HD). Many factors can contribute to intra-HD blood pressure (BP) changes, such as drugs with vasoactive properties that could destabilize already tenuous BP. Intravenous iron sucrose (IS) is commonly administered to correct iron deficiency, however, associations with altered hemodynamics are not consistent.


Using the DaVita Biorepository (n=950), unadjusted and adjusted Poisson and linear repeated measures models were fit to assess the association of IS administration with IDH, IDHyper, and systolic BP (SBP) parameters. Model 1 was adjusted for age, sex, race, access, pre-HD SBP, Model 2; same as model 1, plus ultrafiltration (UF) rate, diabetes, heart failure, ischemic heart disease, peripheral vascular disease, lung disease, and erythropoietin (ESA) dose. Exploratory models were additionally adjusted for hemoglobin and endothelin-1 concentrations.


Mean age was 56 ±20 years, 43% were females, and 38% were Black. Mean pre-HD SBP was 152 ±26 mmHg. Patients who received IS were younger, diabetic, had higher UF rate, and higher frequency of ESA use than those who did not. In fully adjusted models, the risk of IDH was 4% lower (incidence rate ratio [IRR] 0.96; 95%CI 0.93 to 0.99) in HD sessions where IS was administered. There was no association of IS with the risk of IDHyper (IRR 1.02; 95%CI 1.00 to 1.04). Further, in adjusted models, IS was associated with a 1.2 (95%CI 1.0 to 1.5) mmHg higher pre-HD systolic BP, 0.6 (95%CI 0.4 to 0.8) mmHg higher nadir SBP, and 0.7 (95%CI 0.5 to 1.0) mmHg higher post-HD SBP.


We observed an independent association of intravenous IS administration with a lower risk of IDH and higher intra-HD SBP parameters. Future studies to better understand the mechanisms underlying this pattern are warranted.

Association of iron sucrose administration with intradialytic hypotension and hypertension
IRR Ratio (95% CI) for Iron Sucrose administration versus not
 UnadjustedModel 1Model 2Model 2 +HbModel 2 +Hb, +ET-1
(0.90 to 0.96)
(0.91 to 0.98)
(0.93 to 0.99)
(0.93 to 0.99)
(0.92 to 0.99)
(0.98 to 1.03)
(1.02 to 1.06)
(1.00 to 1.04)
(1.00 to 1.04)
(1.00 to 1.04)

Abbreviations: IDH, intradialytic hypotension; IDHyper, intradialytic hypertension; Hb, hemoglobin; ET-1, endothelin-1