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

Lookup NU author(s): Dr Charlie Tomson

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Abstract

© 2021Objectives: 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).

Publication metadata

Author(s): Jhund PS, Petrie MC, Robertson M, Mark PB, MacDonald MR, Connolly E, Anker SD, Bhandari S, Farrington K, Kalra PA, Wheeler DC, Tomson CRV, Ford I, McMurray JJV, Macdougall IC

Publication type: Article

Publication status: Published

Journal: JACC: Heart Failure

Year: 2021

Volume: 9

Issue: 7

Pages: 518-527

Print publication date: 01/07/2021

Online publication date: 09/06/2021

Acceptance date: 01/04/2021

ISSN (print): 2213-1779

ISSN (electronic): 2213-1787

Publisher: Elsevier Inc.

URL: https://doi.org/10.1016/j.jchf.2021.04.005

DOI: 10.1016/j.jchf.2021.04.005

PubMed id: 34119470

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