Intravenous iron administration strategies and anemia management in hemodialysis patients

被引：6

作者：

Michels, Wieneke M. ^{[1
,2
,3
]}

Jaar, Bernard G. ^{[3
,4
,5
,6
]}

Ephraim, Patti L. ^{[3
,6
]}

Liu, Yang ^{[3
,4
]}

Miskulin, Dana C. ^{[7
]}

Tangri, Navdeep ^{[8
]}

Crews, Deidra C. ^{[3
,4
]}

Scialla, Julia J. ^{[9
]}

Shafi, Tariq ^{[3
,4
]}

Sozio, Stephen M. ^{[3
,4
]}

Bandeen-Roche, Karen ^{[4
,10
]}

Cook, Courtney J. ^{[2
,3
]}

Meyer, Klemens B. ^{[7
]}

Boulware, L. Ebony ^{[2
,3
,6
,11
]}

机构：

[1] Acad Med Ctr, Dept Med, Div Nephrol, POB 22660, NL-1100 DD Amsterdam, Netherlands

[2] Johns Hopkins Sch Med, Div Gen Internal Med, Baltimore, MD 21205 USA

[3] Johns Hopkins Med Inst, Welch Ctr Prevent Epidemiol & Clin Res, Baltimore, MD 21205 USA

[4] Johns Hopkins Univ, Sch Med, Dept Med, Div Nephrol, Baltimore, MD 21205 USA

[5] Nephrol Ctr Maryland, Baltimore, MD USA

[6] Johns Hopkins Bloomberg Sch Publ Hlth, Dept Epidemiol, Baltimore, MD USA

[7] Tufts Univ Med, Div Nephrol, Boston, MA USA

[8] Univ Manitoba, Gen Hosp, Div Nephrol, Winnipeg, MB, Canada

[9] Univ Miami, Miller Sch Med, Div Nephrol, Dept Med, Miami, FL 33136 USA

[10] Johns Hopkins Bloomberg Sch Publ Hlth, Dept Biostat, Baltimore, MD USA

[11] Duke Univ, Sch Med, Dept Med, Durham, NC 27706 USA

来源：

NEPHROLOGY DIALYSIS TRANSPLANTATION | 2017年 / 32卷 / 01期

基金：

美国国家卫生研究院; 美国医疗保健研究与质量局;

关键词：

administration strategies; anemia; hemodialysis; iron; mortality; CHRONIC KIDNEY-DISEASE; OUTCOMES; THERAPY; ALPHA;

D O I：

10.1093/ndt/gfw316

中图分类号：

R3 [基础医学]; R4 [临床医学];

学科分类号：

1001 ; 1002 ; 100602 ;

摘要：

Background. The effect of maintenance intravenous (IV) iron administration on subsequent achievement of anemia management goals and mortality among patients recently initiating hemodialysis is unclear. Methods. We performed an observational cohort study, in adult incident dialysis patients starting on hemodialysis. We defined IV administration strategies over a 12-week period following a patient's initiation of hemodialysis; all those receiving IV iron at regular intervals were considered maintenance, and all others were considered non-maintenance. We used multivariable models adjusting for demographics, clinical and treatment parameters, iron dose, measures of iron stores and pro-infectious and pro-inflammatory parameters to compare these strategies. The outcomes under study were patients' (i) achievement of hemoglobin (Hb) of 10-12 g/dL, (ii) more than 25% reduction in mean weekly erythropoietin stimulating agent (ESA) dose and (iii) mortality, ascertained over a period of 4 weeks following the iron administration period. Results. Maintenance IV iron was administered to 4511 patients and non-maintenance iron to 8458 patients. Maintenance IV iron administration was not associated with a higher likelihood of achieving an Hb between 10 and 12 g/dL fadjusted odds ratio (OR) 1.01 [95% confidence interval (CI) 0.93-1.09] g compared with non-maintenance, but was associated with a higher odds of achieving a reduced ESA dose of 25% or more [OR 1.33 (95% CI 1.18-1.49)] and lower mortality [hazard ratio (HR) 0.73 (95% CI 0.62-0.86)]. Conclusions. Maintenance IV iron strategies were associated with reduced ESA utilization and improved early survival but not with the achievement of Hb targets.

引用

页码：173 / 181

页数：9