Article Intravenous Iron Exposure and Mortality in Patients on

Background and objectives Clinical trials assessing effects of larger cumulative iron exposure with outcomes are lacking, and observational studies have been limited by assessment of short-term exposure only and/or failure to assess cause-specific mortality. The associations between short- and long-term iron exposure on all-cause and cause-specific mortality were examined. Design, setting, participants, & measurements The study included 14,078 United States patients on dialysis initiating dialysis between 2003 and 2008. Intravenous iron dose accumulations over 1-, 3-, and 6-month rolling windows were related to all-cause, cardiovascular, and infection-related mortality in Cox proportional hazards models that used marginal structural modeling to control for time-dependent confounding. Results Patients in the 1-month model cohort (n=14,078) were followed a median of 19 months, during which there were 27.6 % all-cause deaths, 13.5 % cardiovascular deaths, and 3 % infection-related deaths. A reduced risk of all-cause mortality with receipt of.150–350 (hazard ratio, 0.78; 95 % confidence interval, 0.64 to 0.95) or.350 mg (hazard ratio, 0.79; 95 % confidence interval, 0.62 to 0.99) intravenous iron compared with.0–150 mg over 1 month was observed. There was no relation of 1-month intravenous iron dose with cardiovascular or infection-related mortality and no relation of 3- or 6-month cumulative intravenous iron dose with all-cause or cardio