High-dose intravenous iron use in hemodialysis patients: Results from the National Health Insurance System (2019–2020) in South Korea

Abstract

Background Intravenous (IV) iron administration is used widely for treating anemia in hemodialysis (HD) patients. In this study, we investigated the safety of IV iron therapy in this population. Methods This study analyzed claims data from the National Health Insurance System and included patients with end-stage renal disease who were receiving HD for more than 3 months as of January 1, 2019. Monthly doses of IV iron were measured for these patients from January 1 to June 30, 2019. Patients were classified into a high- or low-dose group based on the cutoff of a monthly dose of 300 mg iron sucrose. Study outcomes were infection-related hospitalization, cardiovascular events, and all-cause mortality and hospitalization that occurred from July 1, 2019, to December 31, 2020. Results Among 33,527 HD patients, 13,609 (40.6%) and 363 (1.1%) patients were administered IV iron at doses of 1–299 mg/month and ≥300 mg/month, respectively. The mean age was 63 years, and 60.4% were men. Compared with the low-dose group, the high-dose group was younger, had higher percentages of men and Medicaid recipients, and had higher prevalence rates of diabetes and hypertension. The rates of infection-related hospitalization, cardiovascular events, and all-cause hospitalization and mortality were not significantly higher in the high-dose than in the low-dose group. Compared with the 1–100 mg IV iron sucrose dose, higher doses were not associated with an increased risk of outcome events. Conclusion High-dose IV iron administration did not increase rates of mortality or morbidity in HD patients.