Abstract: SA-PO364
Associations of Iron Sucrose and Intradialytic Blood Pressure
Session Information
- Hemodialysis and Frequent Dialysis: CV and Risk Prediction
November 05, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- 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
Background
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.
Methods
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.
Results
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.
Conclusion
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 | |||||
| Unadjusted | Model 1 | Model 2 | Model 2 +Hb | Model 2 +Hb, +ET-1 | |
| IDH | 0.93 (0.90 to 0.96) | 0.94 (0.91 to 0.98) | 0.96 (0.93 to 0.99) | 0.96 (0.93 to 0.99) | 0.95 (0.92 to 0.99) |
| IDHyper | 1.00 (0.98 to 1.03) | 1.04 (1.02 to 1.06) | 1.02 (1.00 to 1.04) | 1.02 (1.00 to 1.04) | 1.02 (1.00 to 1.04) |
Abbreviations: IDH, intradialytic hypotension; IDHyper, intradialytic hypertension; Hb, hemoglobin; ET-1, endothelin-1