Receipt of Intravenous Iron and Clinical Outcomes among Hemodialysis Patients Hospitalized for Infection

Background: People with kidney failure treated with hemodialysis (HD) are at increased risk of stroke compared to similarly aged people with normal kidney function. One concern is that treatment of renal anemia might increase stroke risk. We studied risk factors for stroke in a prespecified secondary analysis of a randomized controlled trial of intravenous iron treatment strategies in HD. Methods: We analyzed data from the Proactive IV IrOn Therapy in HaemodiALysis Patients (PIVOTAL) trial focusing on variables associated with risk of stroke. The trial randomized 2,141 adults, who had started hemodialysis <12 months earlier and who were receiving an erythropoiesis-stimulating agent (ESA), to high-dose IV iron administered proactively or low-dose IV iron administered reactively in a 1:1 ratio. Possible stroke events were independently adjudicated. We performed analyses to identify variables associated with stroke during follow-up and assessed survival following stroke. Results: During a median 2.1 years follow-up, 69 (3.2%) patients experienced a first post randomization stroke. 57 (82.6%) were ischemic strokes and 12 (17.4%) hemorrhagic strokes. There were 34 post randomization strokes in the proactive arm and 35 in the reactive arm (hazard ratio (95% confidence interval): 0.90 (0.56, 1.44), p=0.66). In multivariable models, female gender, diabetes, history of prior stroke at baseline, higher baseline systolic blood pressure, lower serum albumin and higher C-reactive protein were independently associated with stroke events during follow up. Hemoglobin, total iron or ESA dose were not associated with risk of stroke. 58% of patients with a stroke event died during follow-up, compared to 23% without a stroke. Conclusions: In hemodialysis patients, stroke risk is broadly associated with risk factors previously described to increase cardiovascular risk in this population. Proactive intravenous iron does not increase stroke risk.

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The Relationship of a Novel Marker of Inflammation (Neutrophil-to-Lymphocyte Ratio) to Nutritional Status, Diet and Clinical Outcomes in Hemodialysis Patients

10.25148/etd.fidc007708 ◽

2019 ◽

Author(s):

Janet Diaz Martinez

Keyword(s):

Nutritional Status ◽

Clinical Outcomes ◽

Hemodialysis Patients ◽

Neutrophil To Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Relationship Of ◽

The Relationship

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Association of Sepsis with Iron Overload in Hemodialysis Patients Receiving Intravenous Iron Therapy

Asian Journal of Biochemistry ◽

10.3923/ajb.2011.252.262 ◽

2011 ◽

Vol 6 (3) ◽

pp. 252-262 ◽

Cited By ~ 1

Author(s):

Gopu Chinnapu R ◽

Ramakrishna Devaki ◽

Pragna Rao

Keyword(s):

Iron Overload ◽

Intravenous Iron ◽

Hemodialysis Patients ◽

Iron Therapy ◽

Intravenous Iron Therapy

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P1515IMPACT OF POLYPHARMACY ON ALL-CAUSE MORTALITY, ALL-CAUSE HOSPITALIZATION AND CARDIOVASCULAR EVENTS IN INITIAL JAPANESE HEMODIALYSIS PATIENTS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1515 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Tatsunori Toida ◽

Reiko Toida ◽

Shou Ebihara ◽

Shigehiro Uezono ◽

Hiroyuki Komatsu ◽

...

Keyword(s):

Cohort Study ◽

Clinical Outcomes ◽

Cardiovascular Events ◽

Chronic Renal Disease ◽

Risk Index ◽

Hemodialysis Patients ◽

Drug Prescriptions ◽

Increased Risk ◽

All Cause Mortality

Abstract Background and Aims Polypharmacy (PP) is common in end-stage chronic renal disease patients, largely because of the existence of multiple comorbid conditions. PP has the potential for harm and benefits, and the association between PP and mortality and morbidity in hemodialysis patients currently remains unclear. We examined the association of PP and the risk of clinical outcomes, such as all-cause mortality, all-cause hospitalization and cardiovascular events, in initial hemodialysis patients at admission and discharge. Method Study design: Cohort study. Setting: Participants: One hundred and fifty-two initial hemodialysis patients (female vs. male, 88 vs. 64; mean age, 70.3 years) were enrolled between February 2015 and March 2018 at the Nobeoka Prefectural Hospital and Chiyoda Hospital. Predictor: Patients were divided into 2 groups according to PP (6 or more drug prescriptions, or less) during admission and discharge for the initiation of hemodialysis. Outcomes: All-cause mortality, all-cause hospitalization and cardiovascular events (hospitalization due to stroke, ischemic heart disease or peripheral artery disease) during the mean 2.8-year follow-up. Measurements: Hazard ratios (HRs) were estimated using Cox’s model for the relationships between PP and the clinical outcomes, and adjusted for potential confounders, including age, sex, body mass index, systolic and diastolic blood pressure, Charlson comorbidity risk index, hemoglobin, serum levels of albumin, albumin-corrected Ca, phosphate, parathyroid hormone, C-reactive protein and NT-proBNP; and use of erythropoietin stimulating agents. The group with 5 or less drug prescriptions was set as reference. Results Among the patients in this cohort study, the number of prescribed drugs per patient averaged 7.4 at admission and 6.9 at discharge for initial hemodialysis. One hundred (65.8%) and 94 patients (61.8%) had PP at admission and discharge, respectively. During follow-up, 20 patients died, 71 patients were hospitalized and 25 patients had cardiovascular events. PP at admission is significantly associated with cardiovascular events (HR 8.50, 95%CI 1.45-49.68). Furthermore, PP at discharge is significantly associated with all-cause hospitalization and cardiovascular events (HR 1.95, 95%CI 1.01-3.70; HR 53.16, 95%CI 2.70-104.62, respectively). However, PP is not significantly associated with all-cause mortality at admission or discharge. Conclusion Among Japanese patients starting hemodialysis, PP may be associated with clinical outcomes. However, it remains unclear whether PP is the direct cause of the outcomes or is simply a marker for increased risk of outcomes.

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