Kidney Week

Abstract: TH-PO872

Association of Intravenous vs. Oral Iron Therapy with Risk of Infectious Outcomes in Patients with CKD

Session Information

• Anemia and Iron Metabolism
  October 24, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Anemia and Iron Metabolism

• 200 Anemia and Iron Metabolism

Authors

• Shrestha, Prabin, The University of Tennessee Health Science Center, Memphis, Tennessee, United States

Prabin Shrestha, PhD

• Sumida, Keiichi, The University of Tennessee Health Science Center, Memphis, Tennessee, United States

Keiichi Sumida, MD, PhD, MPH, FASN

• Thomas, Fridtjof, The University of Tennessee Health Science Center, Memphis, Tennessee, United States

Fridtjof Thomas, PhD

• Surbhi, Satya, The University of Tennessee Health Science Center, Memphis, Tennessee, United States

Satya Surbhi, PhD

• Naser, Abu Mohd, The University of Memphis, Memphis, Tennessee, United States

Abu Mohd Naser, MBBS, PhD

• Streja, Elani, University of California Irvine, Irvine, California, United States

Elani Streja, PhD, MPH

• Rhee, Connie, University of California Irvine, Irvine, California, United States

Connie Rhee, MD, MS

• Kalantar-Zadeh, Kamyar, University of California Irvine, Irvine, California, United States

Kamyar Kalantar-Zadeh, MD, DrMed, PhD, MPH, FASN

• Kovesdy, Csaba P., The University of Tennessee Health Science Center, Memphis, Tennessee, United States

Csaba P. Kovesdy, MD, FASN

Background

Iron replacement therapy (IRT) is a core component of anemia management in chronic kidney disease (CKD), but its long-term safety remains unclear. Intravenous (IV) IRT has been linked to increased risk of bacterial infections, but the evidence is inconclusive. We investigated the association of IV vs oral IRT with infectious hospitalization and infectious mortality.

Methods

In a national cohort of US Veterans, we identified 18,307 incident new users of IRT with eGFR <60 mL/min/1.73m² at baseline (N=17,428 on oral and 879 on IV iron). We used propensity score overlap weighting to account for differences in baseline characteristics associated with the use of IV vs oral iron. We examined the association of IV vs oral IRT with the incidence of the composite outcome of infectious hospitalization or infectious mortality in competing risk regression models, with non-infectious mortality as the competing event.

Results

The overall mean (SD) age was 73±10 years, 97% were male, 75% were white, and the baseline eGFR, hemoglobin and ferritin levels were 43±13 ml/min/1.73m², 10.6±1.8 gm/dL and 78 mcg/l (25^th-75^th pctl: 26-212), respectively.
There were 4,580 cases of the composite infectious outcome (event rate 98.41/1000PY; 95% CI 95.56-101.27) over a median follow up of 2.12 years. IV IRT (vs oral IRT) was associated with higher crude risk of infection (Figure 1), but the association became statistically non-significant after PS weighting (subhazard ratio, 1.09; 95% CI 0.90-1.32; p-value 0.4) (Figure 1).

Conclusion

In this comparative effectiveness study, IV IRT was associated with similar risk of infectious outcomes as oral IRT.

Funding

• Veterans Affairs Support