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The impact of intravenous ferric carboxymaltose on renal function: an analysis of the FAIR-HF study
Piotr Ponikowski1, Gerasimos Filippatos, Josep Comin Colet
1Medical University, Wroclaw, Poland.
Insights
Intravenous ferric carboxymaltose (FCM) improved renal function in patients with chronic heart failure (CHF) and iron deficiency. This iron therapy was effective and safe, even in those with existing renal dysfunction.
Area of Science:
- Cardiology
- Nephrology
- Hematology
Background:
- Iron deficiency and anemia are common in chronic heart failure (CHF), contributing to the cardio-renal syndrome.
- Understanding the impact of iron supplementation on renal function in these patients is crucial for optimizing treatment.
Purpose of the Study:
- To investigate the effects of intravenous iron (ferric carboxymaltose, FCM) on renal function in iron-deficient CHF patients.
- To assess the efficacy and safety of FCM therapy in CHF patients, particularly those with renal dysfunction.
Main Methods:
- The FAIR-HF trial randomized 459 iron-deficient CHF patients to receive either intravenous ferric carboxymaltose (FCM) or placebo for 24 weeks.
- Renal function was assessed using estimated glomerular filtration rate (eGFR) calculated by the CKD-EPI formula at baseline and at weeks 4, 12, and 24.
- Safety and adverse event profiles were analyzed, comparing patients with baseline eGFR <60 and ≥60 mL/min/1.73 m².
Main Results:
- Treatment with FCM was associated with a statistically significant increase in eGFR compared to placebo at 24 weeks (2.98 ± 1.44 mL/min/1.73 m², P = 0.039).
- This renal improvement effect was consistent across pre-specified subgroups, irrespective of baseline renal function.
- FCM demonstrated similar safety and adverse event profiles in patients with and without baseline renal dysfunction (eGFR <60 vs. ≥60 mL/min/1.73 m²).
Conclusions:
- Intravenous ferric carboxymaltose (FCM) treatment significantly improved renal function in iron-deficient patients with chronic heart failure.
- FCM therapy is an effective and safe treatment option for managing iron deficiency in CHF patients, including those with renal dysfunction.
Aims:
Anaemia and iron deficiency are constituents of the cardio-renal syndrome in chronic heart failure (CHF). We investigated the effects of i.v. iron in iron-deficient CHF patients on renal function, and the efficacy and safety of this therapy in patients with renal dysfunction.
Methods And Results:
The FAIR-HF trial randomized 459 CHF patients with iron deficiency (ferritin <100 µg/L, or between 100 and 299 µg/L if transferrin saturation was <20%): 304 to i.v. ferric carboxymaltose (FCM) and 155 to placebo, and followed-up for 24 weeks. Renal function was assessed at baseline and at weeks 4, 12, and 24, using the estimated glomerular filtration rate (eGFR, mL/min/1.73 m(2) ), calculated from the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula. At baseline, renal function was similar between groups (62.4 ± 20.6 vs. 62.9 ± 23.4 mL/min/1.73 m(2) , FCM vs. placebo). Compared with placebo, treatment with FCM was associated with an increase in eGFR [treatment effect: week 4, 2.11 ± 1.21 (P = 0.082); week 12, 2.41 ± 1.33 (P = 0.070); and week 24, 2.98 ± 1.44 mL/min/1.73 m(2) (P = 0.039)]. This effect was seen in all pre-specified subgroups (P > 0.20 for interactions). No interaction between the favourable effects of FCM and baseline renal function was seen for the primary endpoints [improvement in Patient Global Assessment (P = 0.43) and NYHA class (P = 0.37) at 24 weeks]. Safety and adverse event profiles were similar in patients with baseline eGFR <60 and ≥60 mL/min/1.73 m(2) .
Conclusions:
Treatment of iron deficiency in CHF patients with i.v. FCM was associated with an improvement in renal function. FCM therapy was effective and safe in CHF patients with renal dysfunction.
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