title: Effect of intravenous iron use on hospitalizations in patients undergoing hemodialysis: a comparative effectiveness analysis from the DEcIDE-ESRD study.
abstract: BACKGROUND
  Intravenous iron use in hemodialysis patients has greatly increased over the last decade, despite limited studies on the safety of iron.
  
  
  METHODS
  We studied the association of receipt of intravenous iron with hospitalizations in an incident cohort of hemodialysis patients. We examined 9544 patients from Dialysis Clinic, Inc. (DCI). We ascertained intravenous iron use from DCI electronic medical record and USRDS data files, and hospitalizations through Medicare claims. We examined the association between iron exposure accumulated over 1-, 3- or 6-month time windows and incident hospitalizations in the follow-up period using marginal structural models accounting for time-dependent confounders. We performed sensitivity analyses including recurrent events models for multiple hospitalizations and models for combined outcome of hospitalization and death.
  
  
  RESULTS
  There were 22 347 hospitalizations during a median follow-up of 23 months. Higher cumulative dose of intravenous iron was not associated with all-cause, cardiovascular or infectious hospitalizations [HR 0.97 (95% CI: 0.77-1.22) for all-cause hospitalizations comparing >2100 mg versus 0-900 mg of iron over 6 months]. Findings were similar in models examining the risk of hospitalizations in 1- and 3-month windows [HR 0.88 (95% CI: 0.79-0.99) and HR 0.88 (95% CI: 0.74-1.03), respectively] or the risk of combined outcome of hospitalization and death in the 6-month window [HR 0.98 (95% CI: 0.78-1.23)].
  
  
  CONCLUSIONS
  Higher cumulative dose of intravenous iron may not be associated with increased risk of hospitalizations in hemodialysis patients. While clinical trials are needed, employing higher iron doses to reduce erythropoiesis-stimulating agents does not appear to increase morbidity in routine clinical care.
authors.affiliation: Division of Nephrology, Seven Oaks General Hospital, University of Manitoba, Winnipeg Manitoba, Canada.
authors.forename: Navdeep
authors.initials: N
authors.lastname: Tangri
authors.affiliation: Division of Nephrology, Tufts University School of Medicine, Boston, MA, USA.
authors.forename: Dana C
authors.initials: DC
authors.lastname: Miskulin
authors.affiliation: Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors.forename: Jing
authors.initials: J
authors.lastname: Zhou
authors.affiliation: Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Bandeen-Roche
authors.affiliation: Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA Division of Nephrology, Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Wieneke M
authors.initials: WM
authors.lastname: Michels
authors.affiliation: Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Patti L
authors.initials: PL
authors.lastname: Ephraim
authors.affiliation: Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Aidan
authors.initials: A
authors.lastname: McDermott
authors.affiliation: Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Deidra C
authors.initials: DC
authors.lastname: Crews
authors.affiliation: Division of Nephrology, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Julia J
authors.initials: JJ
authors.lastname: Scialla
authors.affiliation: Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Sozio
authors.affiliation: Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Tariq
authors.initials: T
authors.lastname: Shafi
authors.affiliation: Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA Nephrology Center of Maryland, Baltimore, MD, USA.
authors.forename: Bernard G
authors.initials: BG
authors.lastname: Jaar
authors.affiliation: Division of Nephrology, Tufts University School of Medicine, Boston, MA, USA.
authors.forename: Klemens
authors.initials: K
authors.lastname: Meyer
authors.affiliation: Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: L Ebony
authors.initials: LE
authors.lastname: Boulware
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000209:etiology; D002423:Cause of Death; D016208:Databases, Factual; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D058085:Iron Compounds / Q000008:administration & dosage*; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012307:Risk Factors
chemical_list: D058085:Iron Compounds
keywords: anemia; hemodialysis; hospitalizations; intravenous iron