Robinson BM, et al. - Researchers performed this study to assess the optimal intravenous (IV) iron dosing by estimating the effects of IV iron doses on Hgb, TSAT, ferritin, and erythropoiesis-stimulating agents (ESA) dose in common clinical practice. In this observational study, although residual confounding cannot be ruled out, observations revealed that IV iron dosing <300 mg/month, as commonly seen with maintenance dosing of 100-200 mg/month, could 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. In addition to suggesting 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.

Methods

• Researchers analyzed 9,471 HD patients (11 countries, 2009-2011) in the DOPPS, a prospective cohort study.
• Using adjusted GEE models, they evaluated 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.

Results

• Findings revealed monotonically positive associations between IV iron dose and Hgb, TSAT, and ferritin change, and inverse associations with ESA dose change, across multiple strata of prior Hgb, TSAT, and ferritin levels.
• In this study, 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.
• To numerous sensitivity analyses, findings remained robust.