Heart Failure Hospitalization in Adults Receiving Hemodialysis and the Effect of Intravenous Iron Therapy.

Abstract

OBJECTIVES:

This study sought to examine the effect of intravenous iron on heart failure events in hemodialysis patients.

BACKGROUND:

Heart failure is a common and deadly complication in patients receiving hemodialysis and is difficult to diagnose and treat.

METHODS:

The study analyzed heart failure events in the PIVOTAL (Proactive IV Iron Therapy in Hemodialysis Patients) trial, which compared intravenous iron administered proactively in a high-dose regimen with a low-dose regimen administered reactively. Heart failure hospitalization was an adjudicated outcome, a component of the primary composite outcome, and a prespecified secondary endpoint in the trial.

RESULTS:

Overall, 2,141 participants were followed for a median of 2.1 years. A first fatal or nonfatal heart failure event occurred in 51 (4.7%) of 1,093 patients in the high-dose iron group and in 70 (6.7%) of 1,048 patients in the low-dose group (HR: 0.66; 95% CI: 0.46-0.94; P = 0.023). There was a total of 63 heart failure events (including first and recurrent events) in the high-dose iron group and 98 in the low-dose group, giving a rate ratio of 0.59 (95% CI: 0.40-0.87; P = 0.0084). Most patients presented with pulmonary edema and were mainly treated by mechanical removal of fluid. History of heart failure and diabetes were independent predictors of a heart failure event.

CONCLUSIONS:

Compared with a lower-dose regimen, high-dose intravenous iron decreased the occurrence of first and recurrent heart failure events in patients undergoing hemodialysis, with large relative and absolute risk reductions. (UK Multicentre Open-label Randomised Controlled Trial Of IV Iron Therapy In Incident Haemodialysis Patients; 2013-002267-25).

• Authors: Pardeep S Jhund, Mark C Petrie, Michele Robertson, Patrick B Mark, Michael R MacDonald, Eugene Connolly, Stefan D Anker, Sunil Bhandari, Kenneth Farrington, Philip A Kalra, David C Wheeler, Charles R V Tomson, Ian Ford, John J V McMurray, Iain C Macdougall, PIVOTAL Investigators and Committees
• Journal: JACC. Heart failure (JACC Heart Fail) Vol. 9 Issue 7 Pg. 518-527 (07 2021) ISSN: 2213-1787 [Electronic] United States
• PMID: 34119470 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2021. Published by Elsevier Inc.

Chemical References

• Iron

Topics

• Administration, Intravenous
• Adult
• Heart Failure
• Hospitalization
• Humans
• Iron
• Renal Dialysis