Ko-Lin Kuo1, Szu-Chun Hung1, Jia-Sin Liu2, Yu-Kang Chang2, Chih-Cheng Hsu3, Der-Cherng Tarng4. 1. Division of Nephrology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan School of Medicine, Tzu Chi University, Hualien, Taiwan. 2. Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan. 3. Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan Department of Health Services Administration, China Medical University, Taichung, Taiwan. 4. Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan Department and Institute of Physiology, National Yang-Ming University, Taipei, Taiwan.
Abstract
BACKGROUND: A risk/benefit analysis of iron supplementation in pre-dialysis advanced chronic kidney disease (CKD) patients has not been conducted. We aim to assess the effectiveness and the safety of iron supplementation in patients with CKD Stage 5 who have not yet received dialysis (CKD 5 ND). METHODS: A prospective cohort study was conducted based on the Taiwan National Health Insurance Research Database. From 1 January 2000 to 30 June 2009, we enrolled 31 971 adult patients who had a serum creatinine >6 mg/dL and a haematocrit <28% and who were treated with erythropoiesis-stimulating agents (ESAs). All patients were further divided into two groups with or without iron supplementation within 90 days after starting ESA therapy. Patient follow-up took place until dialysis, death before initiation of dialysis or 31 December 2009. The primary outcomes were death before initiating dialysis, hospitalization before death or long-term dialysis. RESULTS: After propensity score matching, the patients who received iron supplementation were associated with a lower risk of all-cause death [hazard ratio (HR), 0.85; 95% confidence interval (CI), 0.80-0.90] compared with non-users. The survival benefit of iron use was consistent across the majority of dosage groups, except for those who were treated with monthly IV iron >200 mg. Moreover, compared with the non-users, the iron users were associated with a lower risk of hospitalizations (HR, 0.97; 95% CI, 0.94-0.99) but with a higher risk of faster progression to end-stage renal disease (HR, 1.05; 95% CI, 1.01-1.08). CONCLUSIONS: Iron supplementation is associated with 15% risk reduction in death among CKD 5 ND patients who received ESA treatment. Randomized studies are needed to validate this association.
BACKGROUND: A risk/benefit analysis of iron supplementation in pre-dialysis advanced chronic kidney disease (CKD) patients has not been conducted. We aim to assess the effectiveness and the safety of iron supplementation in patients with CKD Stage 5 who have not yet received dialysis (CKD 5 ND). METHODS: A prospective cohort study was conducted based on the Taiwan National Health Insurance Research Database. From 1 January 2000 to 30 June 2009, we enrolled 31 971 adult patients who had a serum creatinine >6 mg/dL and a haematocrit <28% and who were treated with erythropoiesis-stimulating agents (ESAs). All patients were further divided into two groups with or without iron supplementation within 90 days after starting ESA therapy. Patient follow-up took place until dialysis, death before initiation of dialysis or 31 December 2009. The primary outcomes were death before initiating dialysis, hospitalization before death or long-term dialysis. RESULTS: After propensity score matching, the patients who received iron supplementation were associated with a lower risk of all-cause death [hazard ratio (HR), 0.85; 95% confidence interval (CI), 0.80-0.90] compared with non-users. The survival benefit of iron use was consistent across the majority of dosage groups, except for those who were treated with monthly IV iron >200 mg. Moreover, compared with the non-users, the iron users were associated with a lower risk of hospitalizations (HR, 0.97; 95% CI, 0.94-0.99) but with a higher risk of faster progression to end-stage renal disease (HR, 1.05; 95% CI, 1.01-1.08). CONCLUSIONS:Iron supplementation is associated with 15% risk reduction in death among CKD 5 NDpatients who received ESA treatment. Randomized studies are needed to validate this association.
Authors: Angelo Karaboyas; Hal Morgenstern; Sandra Waechter; Nancy L Fleischer; Raymond Vanholder; Stefan H Jacobson; Manish M Sood; Douglas E Schaubel; Masaaki Inaba; Ronald L Pisoni; Bruce M Robinson Journal: Clin Kidney J Date: 2019-07-05
Authors: Maciej Banach; Wilbert S Aronow; Maria-Corina Serban; Jacek Rysz; Luminita Voroneanu; Adrian Covic Journal: Lipids Health Dis Date: 2015-12-30 Impact factor: 3.876