Proactive treatment with high-dose intravenous (IV) iron reduces the risk for classic atherothrombotic myocardial infarction — a type 1 MI — in dialysis patients, an analysis of data from the PIVOTAL trial shows.
However, high-dose iron does not protect against type 2 MIs, which are caused by an acute imbalance in myocardial oxygen supply and demand without accompanying atherothrombosis, the same analysis shows.
"Coronary artery disease is highly prevalent in patients with chronic kidney disease and in those who require hemodialysis, but there are surprisingly few data about how frequently MI occurs, what kind of MIs patients have, or the prognostic significance of these infarctions," said Patrick Mark, MBChB, PhD, professor of nephrology at the Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom.
For their prespecified secondary analysis of PIVOTAL data, Mark and his colleagues compared proactive high-dose IV iron with reactive low-dose IV iron in 2141 hemodialysis patients.
At study enrollment, all patients were taking an erythropoiesis-stimulating agent (ESA), and all had a ferritin concentration below 400 μg/L and transferrin saturation below 30%.
The ESA dose was sufficient to maintain a hemoglobin level of 100 to 120 g/L; otherwise, "patients were treated according to usual practice," Mark reported during his presentation at the virtual European Renal Association–European Dialysis and Transplant Association 57th Congress.
