Variation in intravenous iron use internationally and over time: the Dialysis Outcomes and Practice Patterns Study (DOPPS).
BACKGROUND
To examine patterns of intravenous (IV) iron use across 12 countries from 1999 to 2011.


METHODS
Trends in iron use are described among 32 192 hemodialysis (HD) patients in the Dialysis Outcomes and Practice Patterns Study. Adjusted associations of IV iron dose with serum ferritin and transferrin saturation (TSAT) values were also studied.


RESULTS
IV iron was administered to 50% of patients over 4 months in 1999, increasing to 71% during 2009-11, with increasing use in most countries. Among patients receiving IV iron, the mean monthly dose increased from 232 ± 167 to 281 ± 211 mg. Most countries used 3 to 4 doses/month, but Canada used about 2 doses/month, Italy increased from 3 to almost 6 doses/month and Germany used 5 to 6 doses/month. The USA and most European countries predominantly used iron sucrose and sodium ferric gluconate. A significant use of iron dextran was limited to Canada and France; iron polymaltose was used in Australia and New Zealand; and Japan used ferric oxide saccharate, chondroitin polysulfate iron complex and cideferron. Ferritin values rose in most countries: 22% of patients had ≥ 800 ng/mL in the recent years of study. TSAT levels increased to a lesser degree over time. Japan had much lower IV iron dosing and ferritin levels, but similar TSAT levels. In adjusted analyses, serum ferritin and TSAT levels increased signifcantly by 14 ng/mL and 0.16%, respectively, for every 100 mg/month higher mean monthly iron dose.


CONCLUSIONS
IV iron prescription patterns varied between countries and changed over time from 1999 to 2011. IV iron use and dose increased in most countries, with notable increases in ferritin but not TSAT levels. With rising cumulative IV iron doses, studies of the effects of changing IV iron dosing and other anemia management practices on clinical outcomes should be a high priority.
Albany Nephrology Pharmacy Group (ANephRx), Albany College of Pharmacy and Health Sciences, Albany, NY, USA.
George R
GR
Bailie
Maria
M
Larkina
David A
DA
Goodkin
Yun
Y
Li
Ronald L
RL
Pisoni
Brian
B
Bieber
Nancy
N
Mason
Lin
L
Tong
Francesco
F
Locatelli
Mark R
MR
Marshall
Masaki
M
Inaba
Bruce M
BM
Robinson
D000740:Anemia / Q000188:drug therapy* / Q000209:etiology; D005500:Follow-Up Studies; D006801:Humans; D007501:Iron / Q000627:therapeutic use*; D007674:Kidney Diseases / Q000150:complications* / Q000628:therapy; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011379:Prognosis; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects*
D007501:Iron
hemodialysis; international trends; intravenous iron; iron stores; prescription patterns