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2017 ; 18
(1
): 330
Nephropedia Template TP
gab.com Text
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English Wikipedia
Evaluating the effectiveness of IV iron dosing for anemia management in common
clinical practice: results from the Dialysis Outcomes and Practice Patterns Study
(DOPPS)
#MMPMID29121874
Robinson BM
; Larkina M
; Bieber B
; Kleophas W
; Li Y
; Locatelli F
; McCullough KP
; Nolen JG
; Port FK
; Pisoni RL
BMC Nephrol
2017[Nov]; 18
(1
): 330
PMID29121874
show ga
BACKGROUND: Anemia management protocols in hemodialysis (HD) units differ
conspicuously regarding optimal intravenous (IV) iron dosing; consequently,
patients receive markedly different cumulative exposures to IV iron and
erythropoiesis-stimulating agents (ESAs). Complementary to IV iron safety
studies, our goal was to gain insight into optimal IV iron dosing by estimating
the effects of IV iron doses on Hgb, TSAT, ferritin, and ESA dose in common
clinical practice. METHODS: 9,471 HD patients (11 countries, 2009-2011) in the
DOPPS, a prospective cohort study, were analyzed. Associations of IV iron dose
(3-month average, categorized as 0, <300, ?300 mg/month) with 3-month change in
Hgb, TSAT, ferritin, and ESA dose were evaluated using adjusted GEE models.
RESULTS: Relative change: Monotonically positive associations between IV iron
dose and Hgb, TSAT, and ferritin change, and inverse associations with ESA dose
change, were observed across multiple strata of prior Hgb, TSAT, and ferritin
levels. Absolute change: TSAT, ferritin, and ESA dose changes were nearest zero
with IV iron <300 mg/month, rather than 0 mg/month or ?300 mg/month by
maintenance or replacement dosing. Findings were robust to numerous sensitivity
analyses. CONCLUSIONS: Though residual confounding cannot be ruled out in this
observational study, findings suggest that IV iron dosing <300 mg/month, as
commonly seen with maintenance dosing of 100-200 mg/month, may be a more
effective approach to support Hgb than the higher IV iron doses (300-400
mg/month) often given in many European and North American hemodialysis clinics.
Alongside studies supporting the safety of IV iron in 100-200 mg/month dose
range, these findings help guide the rational dosing of IV iron in anemia
management protocols for everyday hemodialysis practice.