High-Dose, Proactive IV Iron Noninferior in Hemodialysis

High-dose IV iron administered proactively is noninferior to low-dose iron administered reactively.
High-dose IV iron administered proactively is noninferior to low-dose iron administered reactively.

HealthDay News — For patients undergoing maintenance hemodialysis, a high-dose intravenous iron regimen administered proactively is noninferior to a low-dose intravenous iron regimen administered reactively, according to a study published online October 26 in the New England Journal of Medicine to coincide with a presentation at the American Society of Nephrology's Kidney Week, held October 23 to 28 in San Diego.

Iain C. Macdougall, MD, from King's College Hospital in the United Kingdom, and colleagues randomly assigned adults undergoing maintenance hemodialysis to receive high-dose iron sucrose, administered intravenously in a proactive manner, or low-dose iron sucrose, administered intravenously in a reactive manner. Overall, 2141 patients were randomly assigned: 1093 and 1048 to the high- and low-dose groups, respectively. 

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The researchers found that patients received a median monthly iron dose of 264 and 145mg in the high- and low-dose groups, respectively. The median monthly dose of an erythropoiesis-stimulating agent was 29,757 and 38,805 IU in the high- and low-dose groups, respectively. Overall, 30.5% of patients in the high-dose group and 32.7% of patients in the low-dose group had a primary end-point event (nonfatal myocardial infarction, nonfatal stroke, hospitalization for heart failure, or death; hazard ratio, 0.88; 95% confidence interval, 0.76 to 1.03; P<.001 for noninferiority).

"Given the absence of harm that was observed with the high-dose intravenous iron regimen in our trial, the safety and efficacy of even higher doses of iron might be explored in further trials," the authors write.

Several authors disclosed ties to pharmaceutical companies, including Vifor Pharma, which partially funded the study.

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