Evaluating the effectiveness of IV iron dosing for anemia management in common clinical practice: results from the Dialysis Outcomes and Practice Patterns Study (DOPPS)

BMC Nephrology

Research Article

Friedrich K. Port¹  Keith P. McCullough¹  Ronald L. Pisoni¹  Brian Bieber¹  Maria Larkina¹  Bruce M. Robinson²  Yun Li²  Francesco Locatelli³  Werner Kleophas⁴  Jackie G. Nolen⁵ 

[1] Arbor Research Collaborative for Health, 340 E. Huron, Suite 300, 48104, Ann Arbor, MI, USA;Arbor Research Collaborative for Health, 340 E. Huron, Suite 300, 48104, Ann Arbor, MI, USA;University of Michigan, 1415 Washington Heights, 48109, Ann Arbor, MI, USA;Department of Nephrology, Alessandro Manzoni Hospital, Via dell’Eremo, 9/11, 23900, Lecco, LC, Italy;Dialysezentrum Karlstrasse, Karlstraße 17-19, 40210, Düsseldorf, Germany;Vifor Pharma, Flughofstrasse 61, 8152, Glattbrugg, Switzerland;

关键词: anemia;    ferritin;    hemodialysis;    hemoglobin;    IV iron;    TSAT;   

DOI  :  10.1186/s12882-017-0745-9

 received in 2017-02-24, accepted in 2017-10-20,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundAnemia management protocols in hemodialysis (HD) units differ conspicuously regarding optimal intravenous (IV) iron dosing; consequently, patients receive markedly different cumulative exposures to IV iron and erythropoiesis-stimulating agents (ESAs). Complementary to IV iron safety studies, our goal was to gain insight into optimal IV iron dosing by estimating the effects of IV iron doses on Hgb, TSAT, ferritin, and ESA dose in common clinical practice.Methods9,471 HD patients (11 countries, 2009-2011) in the DOPPS, a prospective cohort study, were analyzed. Associations of IV iron dose (3-month average, categorized as 0, <300, ≥300 mg/month) with 3-month change in Hgb, TSAT, ferritin, and ESA dose were evaluated using adjusted GEE models.ResultsRelative change: Monotonically positive associations between IV iron dose and Hgb, TSAT, and ferritin change, and inverse associations with ESA dose change, were observed across multiple strata of prior Hgb, TSAT, and ferritin levels. Absolute change: TSAT, ferritin, and ESA dose changes were nearest zero with IV iron <300 mg/month, rather than 0 mg/month or ≥300 mg/month by maintenance or replacement dosing. Findings were robust to numerous sensitivity analyses.ConclusionsThough residual confounding cannot be ruled out in this observational study, findings suggest that IV iron dosing <300 mg/month, as commonly seen with maintenance dosing of 100-200 mg/month, may be a more effective approach to support Hgb than the higher IV iron doses (300-400 mg/month) often given in many European and North American hemodialysis clinics. Alongside studies supporting the safety of IV iron in 100-200 mg/month dose range, these findings help guide the rational dosing of IV iron in anemia management protocols for everyday hemodialysis practice.

【 授权许可】

CC BY   
© The Author(s). 2017