High-Dose IV Iron Reduces MI in Patients on Hemodialysis

High-dose versus low-dose intravenous iron reduces myocardial infarctions in patients receiving maintenance hemodialysis

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WEDNESDAY, Dec. 22, 2021 (HealthDay News) -- For patients on maintenance hemodialysis, high-dose versus low-dose intravenous (IV) iron can help reduce the risk for myocardial infarction (MI), according to a study published online Dec. 7 in Cardiovascular Research.

Marc C. Petrie, M.B.Ch.B., from the University of Glasgow in the United Kingdom, and colleagues conducted a prespecified analysis of secondary end points from a randomized clinical trial involving adults who had started hemodialysis within the previous year, had a ferritin concentration <400 µg/L, and had a transferrin saturation <30 percent. A total of 2,141 participants were randomly assigned to either high- or low-dose IV iron.

The researchers found that 8.4 percent of participants experienced an MI during a median follow-up of 2.1 years. The rate of type 1 MIs was higher than the rate of type 2 MIs (3.2 versus 1.3/100 patient-years), and non-ST-elevation MIs were more common than ST-elevation MIs (3.3 versus 0.5/100 patient-years). After nonfatal MI, mortality was high (one- and two-year mortality of 40 and 60 percent, respectively). Compared with reactive low-dose IV iron, proactive high-dose IV iron reduced the composite end point of nonfatal and fatal MI (hazard ratio, 0.69) and nonfatal MI (hazard ratio, 0.69) in time-to-first event analysis. High-dose IV iron had less of an effect on recurrent MI events than on the time-to-first event analysis.

"Very few therapies investigated in people on dialysis have been shown to improve outcomes," Petrie said in a statement. "Our hope [is] that this treatment is used around the world in people with kidney failure on dialysis."

Several authors disclosed financial ties to the biopharmaceutical industry; the study was partially funded by Vifor Fresenius Medical Care Renal Pharma.

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