Comparative short-term safety of bolus versus maintenance iron dosing in hemodialysis patients: a replication study Public Deposited

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  • Brookhart, M. Alan
    • Affiliation: Cecil G. Sheps Center for Health Services Research
  • Kshirsagar, Abhijit
    • Affiliation: School of Medicine, UNC Kidney Center
  • Wang, Lily
    • Affiliation: Cecil G. Sheps Center for Health Services Research
  • Ellis, Alan R
    • Affiliation: Cecil G. Sheps Center for Health Services Research
  • Freburger, Janet K
    • Affiliation: Cecil G. Sheps Center for Health Services Research
  • Abstract Background Recent research has reported that patients receiving bolus (frequent large doses to achieve iron repletion) versus maintenance dosing of iron have an increased short-term risk of infection, but a similar risk of cardiovascular events. We sought to determine whether these findings could be replicated using the same methods and a different data source. Methods Clinical data from 6,605 patients of a small U.S. dialysis provider merged with Medicare claims data were examined. Iron dosing patterns (bolus, maintenance, no iron) were identified during 1-month exposure periods and cardiovascular and infection-related outcomes were assessed during 3-month follow-up periods. The effects of bolus versus maintenance dosing were assessed using Cox proportional hazards regression analyses to estimate hazard ratios and semiparametric additive risk models to estimate hazard rate differences, controlling for demographic and clinical characteristics, laboratory values and medications, and comorbidities. Results 48,050 exposure/follow-up periods were examined. 13.9 percent of the exposure periods were bolus dosing, 49.3 percent were maintenance dosing, and the remainder were no iron use. All of the adjusted hazard ratios were >1.00 for the infection-related outcomes, suggesting that bolus dosing increases the risk of these events. The effects were greatest for hospitalized for infection of any major organ system (hazard ratio 1.13 (1.03, 1.24)) and use of intravenous antibiotics (hazard ratio 1.08 (1.02, 1.15). When examining the subgroup of individuals with catheters, the hazard ratios for the infection-related outcomes were generally greater than in the overall sample. There was little association between type of dosing practice and cardiovascular outcomes. Conclusions Results of this study provide further evidence of the association between bolus dosing and increased infection risk, particularly in the subgroup of patients with a catheter, and of the lack of an association between dosing practices and cardiovascular outcomes.
Date of publication
Resource type
  • Article
Rights statement
  • In Copyright
Rights holder
  • Janet K Freburger et al.; licensee BioMed Central Ltd.
Journal title
  • BMC Nephrology
Journal volume
  • 15
Journal issue
  • 1
Page start
  • 154
  • English
Is the article or chapter peer-reviewed?
  • Yes
  • 1471-2369
Bibliographic citation
  • BMC Nephrology. 2014 Sep 22;15(1):154
  • Open Access
  • BioMed Central Ltd

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