title: Comparative outcomes of predominant facility-level use of ferumoxytol versus other intravenous iron formulations in incident hemodialysis patients.
abstract: BACKGROUND
  Ferumoxytol was first approved for clinical use in 2009 solely based on data from trial comparisons with oral iron on biochemical anemia efficacy end points. To compare the rates of important patient outcomes (infection, cardiovascular events and death) between facilities predominantly using ferumoxytol versus iron sucrose (IS) or ferric gluconate (FG) in patients with end-stage renal disease (ESRD)-initiating hemodialysis (HD).
  
  
  METHODS
  Using the United States Renal Data System, we identified all HD facilities that switched (almost) all patients from IS/FG to ferumoxytol (July 2009-December 2011). Each switching facility was matched with three facilities that continued IS/FG use. All incident ESRD patients subsequently initiating HD in these centers were studied and assigned their facility exposure. They were followed for all-cause mortality, cardiovascular hospitalization/death or infectious hospitalization/death. Follow-up ended at kidney transplantation, switch to peritoneal dialysis, transfer to another facility, facility switch to another iron formulation and end of database (31 December 2011). Cox proportional hazards regression was then used to estimate adjusted hazard ratios [HR (95% confidence intervals)].
  
  
  RESULTS
  In July 2009-December 2011, 278 HD centers switched to ferumoxytol; 265 units (95.3%) were matched with 3 units each that continued to use IS/FG. Subsequently, 14 206 patients initiated HD, 3752 (26.4%) in ferumoxytol and 10 454 (73.6%) in IS/FG centers; their characteristics were very similar. During 6433 person-years, 1929 all-cause, 726 cardiovascular and 191 infectious deaths occurred. Patients in ferumoxytol (versus IS/FG) facilities experienced similar all-cause [0.95 (0.85-1.07)], cardiovascular [0.99 (0.83-1.19)] and infectious mortality [0.88 (0.61-1.25)]. Among 5513 Medicare (Parts A + B) beneficiaries, cardiovascular events [myocardial infarction, stroke and cardiovascular death; 1.05 (0.79-1.39)] and infectious events [hospitalization/death; 0.96 (0.85-1.08)] did not differ between the iron exposure groups.
  
  
  CONCLUSIONS
  In incident HD patients, ferumoxytol showed similar short- to mid-term safety profiles with regard to cardiovascular, infectious and mortality outcomes compared with the more commonly used intravenous iron formulations IS and FG.
authors: Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
authors: Medha
authors: M
authors: Airy
authors: Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
authors: Sreedhar
authors: S
authors: Mandayam
authors: Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.
authors: Aya A
authors: AA
authors: Mitani
authors: Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.
authors: Tara I
authors: TI
authors: Chang
authors: Center for Biomedical Informatics Research, Stanford University School of Medicine, Palo Alto, CA, USA.
authors: Victoria Y
authors: VY
authors: Ding
authors: Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
authors: M Alan
authors: MA
authors: Brookhart
authors: Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA.
authors: Benjamin A
authors: BA
authors: Goldstein
authors: Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.
authors: Wolfgang C
authors: WC
authors: Winkelmayer
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D000740:Anemia / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D005290:Ferric Compounds / Q000008:administration & dosage*; D000077605:Ferric Oxide, Saccharated; D052203:Ferrosoferric Oxide / Q000008:administration & dosage*; D005937:Glucaric Acid / Q000008:administration & dosage*; D006397:Hematinics / Q000008:administration & dosage; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000517:prevention & control; D011379:Prognosis; D016016:Proportional Hazards Models; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000188:drug therapy* / Q000209:etiology; D020521:Stroke / Q000209:etiology / Q000517:prevention & control; D014481:United States
chemical_list: D005290:Ferric Compounds; D006397:Hematinics; D000077605:Ferric Oxide, Saccharated; D005937:Glucaric Acid; C035552:ferric gluconate; D052203:Ferrosoferric Oxide
keywords: cardiovascular; infection; intravenous iron; mortality; safety