Stratified analyses showed associations of maintenance IV iron administration with ESA reduction to be strongest among patients with Hb above 12 g/dL at the start of the exposure period; this was also the group with the largest difference in mortality (Table 3). Baseline characteristics did not differ among the subgroups (Supplementary data, Tables S3 and S4).
Odds ratios for IV iron administration strategies with anemia management goals and mortality stratified by hemoglobin at the start
| . | Hb achievement . | P-value . | Reduction in mean weekly ESA dose of 25% or more . | P-value . | Mortality . | P-value . | |||
|---|---|---|---|---|---|---|---|---|---|
| Maintenance n = 4511 . | Non-maintenance n = 8458 . | Maintenance n = 4511 . | Non-maintenance n = 8458 . | Maintenance n = 4708 . | Non-maintenance n = 9145 . | ||||
| Hemoglobin ≤10 g/dL at the start | |||||||||
| Crude | 0.84 (0.60–1.18) | Reference | 0.32 | 1.05 (0.76–1.44) | Reference | 0.76 | 0.78 (0.48–1.28) | Reference | 0.33 |
| Adjusted | 0.81 (0.57–1.16) | Reference | 0.25 | 1.00 (0.70–1.43) | Reference | 1.00 | 1.17 (0.72–1.88) | Reference | 0.53 |
| Hemoglobin 10–12 g/dL at the start | |||||||||
| Crude | 0.86 (0.75–0.98) | Reference | 0.02 | 1.13 (0.93–1.38) | Reference | 0.21 | 0.50 (0.37–0.68) | Reference | < 0.01 |
| Adjusted | 0.94 (0.81–1.08) | Reference | 0.38 | 1.05 (0.85–1.30) | Reference | 0.64 | 0.72 (0.51–1.00) | Reference | 0.05 |
| Hemoglobin ≥12 g/dL at the start | |||||||||
| Crude | 1.00 (0.91–1.11) | Reference | 0.96 | 1.40 (1.18–1.65) | Reference | < 0.01 | 0.52 (0.42–0.65) | Reference | < 0.01 |
| Adjusted | 1.06 (0.96–1.18) | Reference | 0.25 | 1.27 (1.07–1.52) | Reference | 0.01 | 0.69 (0.55–0.87) | Reference | < 0.01 |
| . | Hb achievement . | P-value . | Reduction in mean weekly ESA dose of 25% or more . | P-value . | Mortality . | P-value . | |||
|---|---|---|---|---|---|---|---|---|---|
| Maintenance n = 4511 . | Non-maintenance n = 8458 . | Maintenance n = 4511 . | Non-maintenance n = 8458 . | Maintenance n = 4708 . | Non-maintenance n = 9145 . | ||||
| Hemoglobin ≤10 g/dL at the start | |||||||||
| Crude | 0.84 (0.60–1.18) | Reference | 0.32 | 1.05 (0.76–1.44) | Reference | 0.76 | 0.78 (0.48–1.28) | Reference | 0.33 |
| Adjusted | 0.81 (0.57–1.16) | Reference | 0.25 | 1.00 (0.70–1.43) | Reference | 1.00 | 1.17 (0.72–1.88) | Reference | 0.53 |
| Hemoglobin 10–12 g/dL at the start | |||||||||
| Crude | 0.86 (0.75–0.98) | Reference | 0.02 | 1.13 (0.93–1.38) | Reference | 0.21 | 0.50 (0.37–0.68) | Reference | < 0.01 |
| Adjusted | 0.94 (0.81–1.08) | Reference | 0.38 | 1.05 (0.85–1.30) | Reference | 0.64 | 0.72 (0.51–1.00) | Reference | 0.05 |
| Hemoglobin ≥12 g/dL at the start | |||||||||
| Crude | 1.00 (0.91–1.11) | Reference | 0.96 | 1.40 (1.18–1.65) | Reference | < 0.01 | 0.52 (0.42–0.65) | Reference | < 0.01 |
| Adjusted | 1.06 (0.96–1.18) | Reference | 0.25 | 1.27 (1.07–1.52) | Reference | 0.01 | 0.69 (0.55–0.87) | 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).
Odds ratios for IV iron administration strategies with anemia management goals and mortality stratified by hemoglobin at the start
| . | Hb achievement . | P-value . | Reduction in mean weekly ESA dose of 25% or more . | P-value . | Mortality . | P-value . | |||
|---|---|---|---|---|---|---|---|---|---|
| Maintenance n = 4511 . | Non-maintenance n = 8458 . | Maintenance n = 4511 . | Non-maintenance n = 8458 . | Maintenance n = 4708 . | Non-maintenance n = 9145 . | ||||
| Hemoglobin ≤10 g/dL at the start | |||||||||
| Crude | 0.84 (0.60–1.18) | Reference | 0.32 | 1.05 (0.76–1.44) | Reference | 0.76 | 0.78 (0.48–1.28) | Reference | 0.33 |
| Adjusted | 0.81 (0.57–1.16) | Reference | 0.25 | 1.00 (0.70–1.43) | Reference | 1.00 | 1.17 (0.72–1.88) | Reference | 0.53 |
| Hemoglobin 10–12 g/dL at the start | |||||||||
| Crude | 0.86 (0.75–0.98) | Reference | 0.02 | 1.13 (0.93–1.38) | Reference | 0.21 | 0.50 (0.37–0.68) | Reference | < 0.01 |
| Adjusted | 0.94 (0.81–1.08) | Reference | 0.38 | 1.05 (0.85–1.30) | Reference | 0.64 | 0.72 (0.51–1.00) | Reference | 0.05 |
| Hemoglobin ≥12 g/dL at the start | |||||||||
| Crude | 1.00 (0.91–1.11) | Reference | 0.96 | 1.40 (1.18–1.65) | Reference | < 0.01 | 0.52 (0.42–0.65) | Reference | < 0.01 |
| Adjusted | 1.06 (0.96–1.18) | Reference | 0.25 | 1.27 (1.07–1.52) | Reference | 0.01 | 0.69 (0.55–0.87) | Reference | < 0.01 |
| . | Hb achievement . | P-value . | Reduction in mean weekly ESA dose of 25% or more . | P-value . | Mortality . | P-value . | |||
|---|---|---|---|---|---|---|---|---|---|
| Maintenance n = 4511 . | Non-maintenance n = 8458 . | Maintenance n = 4511 . | Non-maintenance n = 8458 . | Maintenance n = 4708 . | Non-maintenance n = 9145 . | ||||
| Hemoglobin ≤10 g/dL at the start | |||||||||
| Crude | 0.84 (0.60–1.18) | Reference | 0.32 | 1.05 (0.76–1.44) | Reference | 0.76 | 0.78 (0.48–1.28) | Reference | 0.33 |
| Adjusted | 0.81 (0.57–1.16) | Reference | 0.25 | 1.00 (0.70–1.43) | Reference | 1.00 | 1.17 (0.72–1.88) | Reference | 0.53 |
| Hemoglobin 10–12 g/dL at the start | |||||||||
| Crude | 0.86 (0.75–0.98) | Reference | 0.02 | 1.13 (0.93–1.38) | Reference | 0.21 | 0.50 (0.37–0.68) | Reference | < 0.01 |
| Adjusted | 0.94 (0.81–1.08) | Reference | 0.38 | 1.05 (0.85–1.30) | Reference | 0.64 | 0.72 (0.51–1.00) | Reference | 0.05 |
| Hemoglobin ≥12 g/dL at the start | |||||||||
| Crude | 1.00 (0.91–1.11) | Reference | 0.96 | 1.40 (1.18–1.65) | Reference | < 0.01 | 0.52 (0.42–0.65) | Reference | < 0.01 |
| Adjusted | 1.06 (0.96–1.18) | Reference | 0.25 | 1.27 (1.07–1.52) | Reference | 0.01 | 0.69 (0.55–0.87) | 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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