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

BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom. Robertson Centre for Biostatistics, University of Glasgow, Glasgow, United Kingdom. Department of Cardiology, Changi General Hospital, Singapore. Department of Cardiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany. Department of Nephrology, Hull and East Yorkshire Hospitals NHS Trust and Hull York, Hull York Medical School, Hull, United Kingdom. Department of Nephrology, Lister Hospital, Stevenage, United Kingdom. Department of Nephrology, Salford Royal NHS Foundation Trust, Salford, United Kingdom. Department of Nephrology, University College London, London, United Kingdom; Department of Nephrology, George Institute for Global Health, Sydney, Australia. Department of Nephrology, Freeman Hospital, Newcastle upon Tyne, United Kingdom. BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom. Electronic address: john.mcmurray@glasgow.ac.uk. Department of Renal Medicine, King's College Hospital, London, United Kingdom.

JACC. Heart failure. 2021
PICO Summary

Population

Haemodialysis patients enrolled in the PIVOTAL trial (n= 2,141).

Intervention

Intravenous iron administered proactively in a high-dose regimen (n= 1,093).

Comparison

Low-dose regimen administered reactively (n= 1,048).

Outcome

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. 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. Most patients presented with pulmonary oedema and were mainly treated by mechanical removal of fluid. History of heart failure and diabetes were independent predictors of a heart failure event.
Abstract
OBJECTIVES The 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. CONCLUSION 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).
Study details
Language : eng
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