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Published on: March 14, 2017
Long-Term Intravenous Iron Therapy and Morbidity in Hemodialysis Patients
Ana Maria Mehedinti1, Cristina Capusa1, Iuliana Andreiana1
1Nephrology Department, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
Insights
Higher doses of intravenous iron sucrose in hemodialysis patients correlated with increased hospitalization risk. Long-term iron therapy showed limited impact on specific morbidity causes in non-diabetic patients.
Area of Science:
- Nephrology
- Hematology
- Clinical Pharmacy
Background:
- This study investigated long-term intravenous iron therapy's impact on morbidity in hemodialysis patients.
- A retrospective cohort study compared iron sucrose-treated and untreated patients over one year.
- Exclusion criteria included diabetic nephropathy, pregnancy, and incomplete data.
Discussion:
- Hospitalization rates did not differ between iron-treated and untreated groups.
- However, hospitalization risk significantly increased with higher monthly doses of iron sucrose (100 mg, 200 mg, 400 mg).
- Rates of hospitalization for infectious and cardiovascular diseases were similar across groups.
Key Insights:
- Intravenous iron sucrose, particularly at higher doses, is associated with increased hospitalization risk in hemodialysis patients.
- The overall long-term morbidity impact of iron therapy appears limited in non-diabetic hemodialysis patients.
- Dose optimization of intravenous iron is crucial for patient safety.
Outlook:
- Further research is needed to explore the mechanisms linking higher iron doses to hospitalization.
- Investigating alternative iron formulations or administration protocols may mitigate risks.
- Longitudinal studies with larger cohorts are recommended to confirm these findings.
Abstract:
Objective: The aim of this study was to describe long-term intravenous iron therapy-associated morbidity in hemodialysis patients from a single Hemodialysis Center. Material and methods: We conducted an observational retrospective cohort study from 01 January to 31 December 2015. Two hundred and twenty prevalent patients on maintenance hemodialysis therapy for at least 12 months (mean age 53±13 years, 56% males, median hemodialysis vintage 5 (1-26) years) were included. Diabetic nephropathy as primary kidney disease, pregnancy and incomplete data records regarding study aims were exclusion criteria. We compared the frequency, duration and causes of hospitalizations in iron sucrose-treated versus gender and age-matched iron non-treated patients. Differences between groups were assessed using Chi-square and Kruskal-Wallis H tests. A p value μ0.05 was considered statistically significant. Results: From the entire cohort, 68% were iron-treated. One in five patients were treated with higher doses (400 mg monthly), and lower doses were used (100-200 mg monthly) in 80% of patients. There were no differences regarding the rates of admission between the two groups (56/100 patient-years in the iron sucrose-treated vs. 50/100 patient-years in the iron-untreated group, p=0.1). Still, the hospitalization rate significantly increased with the administered iron dose (0.4 vs. 0.7 vs. 0.8/100 patient-years for 100 mg vs. 200 mg vs. 400 mg monthly, respectively, p=0.006). Hospitalization rates due to infectious and cardiovascular diseases were similar for both groups (12/100 patient-years vs. 5.7/100 patient-years, p=0.3 and 11.3/100 patient-years vs. 4.3/100 patient-years, p=0.2, respectively). Conclusion: Higher doses of intravenous iron sucrose appear to be associated with an elevated risk of hospitalization. Nonetheless, long-term intravenous iron therapy seems to have a limited influence in terms of specific cause of morbidity in non-diabetic hemodialysis patients.
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