Effects of intravenous iron therapy on mortality and hospitalization of hemodialysis patients: A prospective cohort study in Korea

Abstract

Iron replacement therapy is necessary for anemia treatment in patients with advanced chronic kidney disease. Intra-venous (IV) iron therapy is an efficient meth-od for iron replacement. However, there are concerns regarding its considerable side effects, including increased risks of infec-tion or major adverse cardiovascular events (MACE). This is a longitudinal study from a multicenter prospective cohort study con-ducted in the Korean end-stage renal dis-ease population. All-cause mortality, death due to infection or MACE, hospitalization due to infection or MACE, and all adverse event of death or hospitalization due to in-fection or MACE were compared according to the iron replacement methods during the first 3 months of enrollment. Among 1,680 hemodialysis patients, 29.3% of patients re-ceived IV iron therapy, and 38% of patients received oral iron therapy. During the me-dian 632 days follow-up, all-cause mortality, mortality or hospitalization due to infection or MACE, and all adverse events did not dif -fer among iron replacement groups. There were significant differences related to the risk of all adverse events among iron re-placement therapies in the log-rank test and univariate Cox regression analysis only in the prevalent dialysis patients; however, the sig-nificance was lost in multivariate Cox regres-sion analysis. Similar results were observed in the 1-year short-term outcome analysis. High-dose IV iron did not increase adverse outcomes. All-cause mortality or all adverse events due to infection or MACE were not higher with the current clinical regimen of IV iron replacement therapy than with oral or no iron therapy in Korean hemodialysis patients.