Related Experiment Video
Updated: Aug 15, 2025
Continuous Manual Exchange Transfusion for Patients with Sickle Cell Disease: An Efficient Method to Avoid Iron Overload
Published on: March 14, 2017
Associations of Iron Sucrose and Intradialytic Blood Pressure
Anika T Singh1, Timothy E Yen1, Suraj Sarvode Mothi2
1Renal Division, Department of Medicine, Brigham and Women's Hospital, Medical School, Boston, Massachusetts.
Insights
Intravenous iron sucrose administration during hemodialysis (HD) is linked to reduced intradialytic hypotension but increased intradialytic hypertension. Higher doses of iron sucrose were associated with these opposing blood pressure changes in HD patients.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Pharmacology
Background:
- Intradialytic hypotension and hypertension are significant complications in hemodialysis (HD), impacting patient morbidity and mortality.
- Medications administered during HD, including intravenous iron sucrose for iron deficiency, can influence hemodynamic stability.
- Previous reports on iron sucrose's hemodynamic effects have yielded inconsistent findings.
Purpose of the Study:
- To investigate the association between intravenous iron sucrose administration during maintenance hemodialysis and intradialytic blood pressure changes.
- To determine the relationship between iron sucrose dosage and the occurrence of intradialytic hypotension and hypertension.
Main Methods:
- A prospective cohort study involving 950 outpatients undergoing maintenance hemodialysis.
- Iron sucrose administration during hemodialysis sessions was the primary exposure.
- Intradialytic hypotension, intradialytic hypertension, and systolic blood pressure parameters were the main outcomes.
- Unadjusted and adjusted Poisson and linear repeated measures regression models were employed for analysis.
Main Results:
- Higher doses of iron sucrose (≥100mg) were independently associated with an 11% lower rate of intradialytic hypotension (IRR, 0.89).
- Conversely, higher doses of iron sucrose were associated with a 7% increased rate of intradialytic hypertension (IRR, 1.07).
- Patients receiving higher iron sucrose doses were more likely to have diabetes, longer HD sessions, and higher erythropoiesis-stimulating agent use.
Conclusions:
- Intravenous iron sucrose administration during hemodialysis is independently associated with a reduced risk of intradialytic hypotension.
- Higher doses of iron sucrose during hemodialysis are linked to an increased risk of intradialytic hypertension.
- Further research is warranted to elucidate the underlying mechanisms of these observed hemodynamic associations.
Rationale & Objective:
Intradialytic hypotension and intradialytic hypertension are associated with morbidity and mortality in hemodialysis (HD). Many factors can contribute to intra-HD blood pressure (BP) changes, such as drugs with vasoactive properties that can destabilize an already tenuous BP. Intravenous iron sucrose is commonly administered to correct iron deficiency; however, its reported associations with altered hemodynamics have not been consistent.
Study Design:
Prospective cohort study.
Setting & Participants:
950 outpatients receiving maintenance HD.
Exposure:
Iron sucrose administered during HD.
Outcome:
Intradialytic hypotension, intradialytic hypertension, systolic blood pressure parameters.
Analytical Approach:
Unadjusted and adjusted Poisson and linear repeated measures regression models.
Results:
The mean age of patients included in the study was 53±22 years, 43% were female, and 38% were Black. Mean pre-HD SBP was 152±26 (SD) mm Hg. At baseline, the patients who received higher doses of iron sucrose tended to have diabetes, have longer HD sessions, and have a higher frequency of erythropoiesis-stimulating agent use, compared with those who did not receive iron sucrose. In adjusted models, higher doses of iron sucrose were associated with an 11% lower rate of intradialytic hypotension (incidence rate ratio [IRR] for iron sucrose≥100mg vs 0 mg, 0.89 [95% CI, 0.85-0.94]). In adjusted analyses, the administration of higher doses of iron sucrose during HD was associated with intradialytic hypertension (IRR for iron sucrose≥100mg vs 0 mg, 1.07 [95% CI, 1.04-1.10]).
Limitations:
Nonavailability of the precise iron sucrose formulation (volume), laboratory data for each HD session, and outpatient medications. Objective measures of volume status, home medications, and symptom data were not recorded in this study.
Conclusions:
We observed an independent association of intravenous iron sucrose administration during HD with a lower risk of intradialytic hypotension and higher risk of intradialytic hypertension. Future studies to better understand the mechanisms underlying these associations are warranted.
Plain-Language Summary:
Intradialytic hypotension and intradialytic hypertension are common among patients on hemodialysis, and they are associated with morbidity and mortality. Although many factors may contribute to these risks, medications administered during hemodialysis play an important role. We studied the significance of the intravenous iron sucrose used to treat iron deficiency and the impact it may have on blood pressure during dialysis. In our study of 950 outpatient hemodialysis patients, we observed that administration of iron sucrose was associated with higher systolic blood pressure (during and after hemodialysis sessions) as well as a lower risk of intradialytic hypotension. We also observed that higher doses of iron sucrose are associated with the development of intradialytic hypertension.
More Related Videos
Related Concept Videos
01:22Heart Failure VI: Adjunct Therapies
01:25Hemodialysis III: Nursing Management
01:17Hormonal Regulation of Blood Pressure
Epinephrine and Norepinephrine
The adrenal medulla releases epinephrine and norepinephrine, catecholamines that enhance and extend the sympathetic or "fight or flight" physiological response. These hormones escalate heart rate and the force of contraction...
01:24Hemodialysis II: Procedure and Complications
01:25Peritoneal Dialysis III: Nursing Management
01:16Antihypertensive Drugs: Action of Diuretics