Although statistically significant, the 0.1 g/dL (P < 0.01) difference in mean Hb between both IV iron strategies was not clinically relevant [Hb maintenance group 12.1 (SD 1.3); non-maintenance 11.99 (1.4) g/dL]. After adjustment, patients administered maintenance IV iron were not more likely to achieve Hb targets. The mean weekly ESA dose was 20.1 units/kg lower (P < 0.01) among patients administered maintenance IV iron [ESA dose maintenance group 223.9 (SD 235.1); non-maintenance 244.8 (SD 265.7) units/kg] (Figure 3). This difference persisted after full adjustment, with 15% greater odds of a more than 25% reduction in ESA dose among patients treated with maintenance when compared with non-maintenance IV iron (Table 2).
Differences in hemoglobin levels and mean weekly erythropoietin stimulating agent (ESA) doses before and after the exposure period. The figure represents the difference in means of hemoglobin levels and mean weekly doses corrected for body weight (units/kg).
FIGURE 3

Differences in hemoglobin levels and mean weekly erythropoietin stimulating agent (ESA) doses before and after the exposure period. The figure represents the difference in means of hemoglobin levels and mean weekly doses corrected for body weight (units/kg).

Table 2

Odds ratios for IV iron administration strategy with achievement of anemia management goals

Anemia management goalsMaintenance (n = 4511)Non-maintenance (n = 8458)P-value
Achievement of hemoglobin 10–12 g/dL
 Crude0.95 (0.88–1.03)Reference0.19
 Adjusted1.01 (0.93–1.09)Reference0.86
Reduction in mean weekly ESA dose of 25% or more
 Crude1.33 (1.18–1.49)Reference< 0.01
 Adjusted1.15 (1.02–1.30)Reference0.02
MortalityMaintenance n = 4708Non-maintenance n = 9145
Crude0.52 (0.44–0.62)Reference< 0.01
Adjusted0.73 (0.62–0.86)Reference< 0.01
Anemia management goalsMaintenance (n = 4511)Non-maintenance (n = 8458)P-value
Achievement of hemoglobin 10–12 g/dL
 Crude0.95 (0.88–1.03)Reference0.19
 Adjusted1.01 (0.93–1.09)Reference0.86
Reduction in mean weekly ESA dose of 25% or more
 Crude1.33 (1.18–1.49)Reference< 0.01
 Adjusted1.15 (1.02–1.30)Reference0.02
MortalityMaintenance n = 4708Non-maintenance n = 9145
Crude0.52 (0.44–0.62)Reference< 0.01
Adjusted0.73 (0.62–0.86)Reference< 0.01

ESA is erythropoietin stimulating agent. Adjusted analyses include demographic, clinical and treatment parameters (age, sex, race, ethnicity, cause of end-stage renal disease, comorbidity and year of dialysis initiation), total iron dose during the exposure period, measures of iron stores (transferrin saturation and ferritin) and hemoglobin at the start of the exposure period, mean weekly erythropoietin stimulating agent dose in units/kg during the exposure period and pro-infectious and pro-inflammatory parameters (vascular access, serum albumin, serum creatinine and recent infection).

Table 2

Odds ratios for IV iron administration strategy with achievement of anemia management goals

Anemia management goalsMaintenance (n = 4511)Non-maintenance (n = 8458)P-value
Achievement of hemoglobin 10–12 g/dL
 Crude0.95 (0.88–1.03)Reference0.19
 Adjusted1.01 (0.93–1.09)Reference0.86
Reduction in mean weekly ESA dose of 25% or more
 Crude1.33 (1.18–1.49)Reference< 0.01
 Adjusted1.15 (1.02–1.30)Reference0.02
MortalityMaintenance n = 4708Non-maintenance n = 9145
Crude0.52 (0.44–0.62)Reference< 0.01
Adjusted0.73 (0.62–0.86)Reference< 0.01
Anemia management goalsMaintenance (n = 4511)Non-maintenance (n = 8458)P-value
Achievement of hemoglobin 10–12 g/dL
 Crude0.95 (0.88–1.03)Reference0.19
 Adjusted1.01 (0.93–1.09)Reference0.86
Reduction in mean weekly ESA dose of 25% or more
 Crude1.33 (1.18–1.49)Reference< 0.01
 Adjusted1.15 (1.02–1.30)Reference0.02
MortalityMaintenance n = 4708Non-maintenance n = 9145
Crude0.52 (0.44–0.62)Reference< 0.01
Adjusted0.73 (0.62–0.86)Reference< 0.01

ESA is erythropoietin stimulating agent. Adjusted analyses include demographic, clinical and treatment parameters (age, sex, race, ethnicity, cause of end-stage renal disease, comorbidity and year of dialysis initiation), total iron dose during the exposure period, measures of iron stores (transferrin saturation and ferritin) and hemoglobin at the start of the exposure period, mean weekly erythropoietin stimulating agent dose in units/kg during the exposure period and pro-infectious and pro-inflammatory parameters (vascular access, serum albumin, serum creatinine and recent infection).

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