Receipt of intravenous iron and clinical outcomes among hemodialysis patients hospitalized for infection

Julie H. Ishida, Ben J. Marafino, Charles E. McCulloch, Lorien Dalrymple, R. Adams Dudley, Barbara A. Grimes, Kirsten L. Johansen

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background and objectives Anemia guidelines for CKD recommend withholding intravenous iron in the setting of active infection, although no data specifically support this recommendation. This study aimed to examine the association between intravenous iron and clinical outcomes among hemodialysis patients hospitalized for infection. Design, setting, participants, & measurements This was a retrospective observational cohort study using data from the US Renal Data System of 22,820 adult Medicare beneficiaries on in-center hemodialysis who had received intravenous iron in the 14 days preceding their first hospitalization for bacterial infection in 2010. In multivariable analyses, the association between receipt of intravenous iron at any point from the day of hospital admission to discharge and all-cause 30-day mortality, mortality in 2010, length of hospital stay, and readmission for infection or death within 30 days of discharge was evaluated. Results There were 2463 patients (10.8%) who received intravenous iron at any point from the day of admission to discharge. Receipt of intravenous iron was not associated with age, dialysis vintage, or comorbidities. There were 2618 deaths within 30 days of admission and 6921 deaths in 2010 (median follow-up 173 days; 25th and 75th percentiles, 78–271 days). The median length of stay was 7 days (25th and 75th percentiles, 5–12 days). Receipt of intravenous iron was not associated with higher 30-day mortality (odds ratio, 0.86; 95% confidence interval [95% CI], 0.74 to 1.00), higher mortality in 2010 (hazard ratio, 0.92; 95% CI, 0.85 to 1.00), longer mean length of stay (10.1 days [95% CI, 9.7 to 10.5] versus 10.5 days [95% CI, 10.3 to 10.7]; P=0.05), or readmission for infection or death within 30 days of discharge (odds ratio, 1.08; 95% CI, 0.96 to 1.22) compared with no receipt of intravenous iron. Conclusions This analysis does not support withholding intravenous iron upon admission for bacterial infection in hemodialysis patients, although clinical trials are required to make definitive recommendations.

Original languageEnglish (US)
Pages (from-to)1799-1805
Number of pages7
JournalClinical Journal of the American Society of Nephrology
Volume10
Issue number10
DOIs
StatePublished - Oct 7 2015

Fingerprint

Renal Dialysis
Iron
Infection
Confidence Intervals
Length of Stay
Mortality
Bacterial Infections
Odds Ratio
Patient Readmission
Medicare
Information Systems
Observational Studies
Comorbidity
Anemia
Dialysis
Hospitalization
Cohort Studies
Clinical Trials
Guidelines
Kidney

ASJC Scopus subject areas

  • Nephrology
  • Transplantation
  • Epidemiology
  • Critical Care and Intensive Care Medicine

Cite this

Ishida, J. H., Marafino, B. J., McCulloch, C. E., Dalrymple, L., Dudley, R. A., Grimes, B. A., & Johansen, K. L. (2015). Receipt of intravenous iron and clinical outcomes among hemodialysis patients hospitalized for infection. Clinical Journal of the American Society of Nephrology, 10(10), 1799-1805. https://doi.org/10.2215/CJN.01090115

Receipt of intravenous iron and clinical outcomes among hemodialysis patients hospitalized for infection. / Ishida, Julie H.; Marafino, Ben J.; McCulloch, Charles E.; Dalrymple, Lorien; Dudley, R. Adams; Grimes, Barbara A.; Johansen, Kirsten L.

In: Clinical Journal of the American Society of Nephrology, Vol. 10, No. 10, 07.10.2015, p. 1799-1805.

Research output: Contribution to journalArticle

Ishida, JH, Marafino, BJ, McCulloch, CE, Dalrymple, L, Dudley, RA, Grimes, BA & Johansen, KL 2015, 'Receipt of intravenous iron and clinical outcomes among hemodialysis patients hospitalized for infection', Clinical Journal of the American Society of Nephrology, vol. 10, no. 10, pp. 1799-1805. https://doi.org/10.2215/CJN.01090115
Ishida, Julie H. ; Marafino, Ben J. ; McCulloch, Charles E. ; Dalrymple, Lorien ; Dudley, R. Adams ; Grimes, Barbara A. ; Johansen, Kirsten L. / Receipt of intravenous iron and clinical outcomes among hemodialysis patients hospitalized for infection. In: Clinical Journal of the American Society of Nephrology. 2015 ; Vol. 10, No. 10. pp. 1799-1805.
@article{80ca6143225c496ab031682c130f8560,
title = "Receipt of intravenous iron and clinical outcomes among hemodialysis patients hospitalized for infection",
abstract = "Background and objectives Anemia guidelines for CKD recommend withholding intravenous iron in the setting of active infection, although no data specifically support this recommendation. This study aimed to examine the association between intravenous iron and clinical outcomes among hemodialysis patients hospitalized for infection. Design, setting, participants, & measurements This was a retrospective observational cohort study using data from the US Renal Data System of 22,820 adult Medicare beneficiaries on in-center hemodialysis who had received intravenous iron in the 14 days preceding their first hospitalization for bacterial infection in 2010. In multivariable analyses, the association between receipt of intravenous iron at any point from the day of hospital admission to discharge and all-cause 30-day mortality, mortality in 2010, length of hospital stay, and readmission for infection or death within 30 days of discharge was evaluated. Results There were 2463 patients (10.8{\%}) who received intravenous iron at any point from the day of admission to discharge. Receipt of intravenous iron was not associated with age, dialysis vintage, or comorbidities. There were 2618 deaths within 30 days of admission and 6921 deaths in 2010 (median follow-up 173 days; 25th and 75th percentiles, 78–271 days). The median length of stay was 7 days (25th and 75th percentiles, 5–12 days). Receipt of intravenous iron was not associated with higher 30-day mortality (odds ratio, 0.86; 95{\%} confidence interval [95{\%} CI], 0.74 to 1.00), higher mortality in 2010 (hazard ratio, 0.92; 95{\%} CI, 0.85 to 1.00), longer mean length of stay (10.1 days [95{\%} CI, 9.7 to 10.5] versus 10.5 days [95{\%} CI, 10.3 to 10.7]; P=0.05), or readmission for infection or death within 30 days of discharge (odds ratio, 1.08; 95{\%} CI, 0.96 to 1.22) compared with no receipt of intravenous iron. Conclusions This analysis does not support withholding intravenous iron upon admission for bacterial infection in hemodialysis patients, although clinical trials are required to make definitive recommendations.",
author = "Ishida, {Julie H.} and Marafino, {Ben J.} and McCulloch, {Charles E.} and Lorien Dalrymple and Dudley, {R. Adams} and Grimes, {Barbara A.} and Johansen, {Kirsten L.}",
year = "2015",
month = "10",
day = "7",
doi = "10.2215/CJN.01090115",
language = "English (US)",
volume = "10",
pages = "1799--1805",
journal = "Clinical Journal of the American Society of Nephrology",
issn = "1555-9041",
publisher = "American Society of Nephrology",
number = "10",

}

TY - JOUR

T1 - Receipt of intravenous iron and clinical outcomes among hemodialysis patients hospitalized for infection

AU - Ishida, Julie H.

AU - Marafino, Ben J.

AU - McCulloch, Charles E.

AU - Dalrymple, Lorien

AU - Dudley, R. Adams

AU - Grimes, Barbara A.

AU - Johansen, Kirsten L.

PY - 2015/10/7

Y1 - 2015/10/7

N2 - Background and objectives Anemia guidelines for CKD recommend withholding intravenous iron in the setting of active infection, although no data specifically support this recommendation. This study aimed to examine the association between intravenous iron and clinical outcomes among hemodialysis patients hospitalized for infection. Design, setting, participants, & measurements This was a retrospective observational cohort study using data from the US Renal Data System of 22,820 adult Medicare beneficiaries on in-center hemodialysis who had received intravenous iron in the 14 days preceding their first hospitalization for bacterial infection in 2010. In multivariable analyses, the association between receipt of intravenous iron at any point from the day of hospital admission to discharge and all-cause 30-day mortality, mortality in 2010, length of hospital stay, and readmission for infection or death within 30 days of discharge was evaluated. Results There were 2463 patients (10.8%) who received intravenous iron at any point from the day of admission to discharge. Receipt of intravenous iron was not associated with age, dialysis vintage, or comorbidities. There were 2618 deaths within 30 days of admission and 6921 deaths in 2010 (median follow-up 173 days; 25th and 75th percentiles, 78–271 days). The median length of stay was 7 days (25th and 75th percentiles, 5–12 days). Receipt of intravenous iron was not associated with higher 30-day mortality (odds ratio, 0.86; 95% confidence interval [95% CI], 0.74 to 1.00), higher mortality in 2010 (hazard ratio, 0.92; 95% CI, 0.85 to 1.00), longer mean length of stay (10.1 days [95% CI, 9.7 to 10.5] versus 10.5 days [95% CI, 10.3 to 10.7]; P=0.05), or readmission for infection or death within 30 days of discharge (odds ratio, 1.08; 95% CI, 0.96 to 1.22) compared with no receipt of intravenous iron. Conclusions This analysis does not support withholding intravenous iron upon admission for bacterial infection in hemodialysis patients, although clinical trials are required to make definitive recommendations.

AB - Background and objectives Anemia guidelines for CKD recommend withholding intravenous iron in the setting of active infection, although no data specifically support this recommendation. This study aimed to examine the association between intravenous iron and clinical outcomes among hemodialysis patients hospitalized for infection. Design, setting, participants, & measurements This was a retrospective observational cohort study using data from the US Renal Data System of 22,820 adult Medicare beneficiaries on in-center hemodialysis who had received intravenous iron in the 14 days preceding their first hospitalization for bacterial infection in 2010. In multivariable analyses, the association between receipt of intravenous iron at any point from the day of hospital admission to discharge and all-cause 30-day mortality, mortality in 2010, length of hospital stay, and readmission for infection or death within 30 days of discharge was evaluated. Results There were 2463 patients (10.8%) who received intravenous iron at any point from the day of admission to discharge. Receipt of intravenous iron was not associated with age, dialysis vintage, or comorbidities. There were 2618 deaths within 30 days of admission and 6921 deaths in 2010 (median follow-up 173 days; 25th and 75th percentiles, 78–271 days). The median length of stay was 7 days (25th and 75th percentiles, 5–12 days). Receipt of intravenous iron was not associated with higher 30-day mortality (odds ratio, 0.86; 95% confidence interval [95% CI], 0.74 to 1.00), higher mortality in 2010 (hazard ratio, 0.92; 95% CI, 0.85 to 1.00), longer mean length of stay (10.1 days [95% CI, 9.7 to 10.5] versus 10.5 days [95% CI, 10.3 to 10.7]; P=0.05), or readmission for infection or death within 30 days of discharge (odds ratio, 1.08; 95% CI, 0.96 to 1.22) compared with no receipt of intravenous iron. Conclusions This analysis does not support withholding intravenous iron upon admission for bacterial infection in hemodialysis patients, although clinical trials are required to make definitive recommendations.

UR - http://www.scopus.com/inward/record.url?scp=84943780049&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84943780049&partnerID=8YFLogxK

U2 - 10.2215/CJN.01090115

DO - 10.2215/CJN.01090115

M3 - Article

C2 - 26416943

AN - SCOPUS:84943780049

VL - 10

SP - 1799

EP - 1805

JO - Clinical Journal of the American Society of Nephrology

JF - Clinical Journal of the American Society of Nephrology

SN - 1555-9041

IS - 10

ER -