Heart failure hospitalization in adults receiving maintenance hemodialysis and effect of intravenous iron therapy: A report from PIVOTAL

Jhund, P. S. et al. (2021) Heart failure hospitalization in adults receiving maintenance hemodialysis and effect of intravenous iron therapy: A report from PIVOTAL. JACC: Heart Failure, 9(7), pp. 518-527. (doi: 10.1016/j.jchf.2021.04.005) (PMID:34119470)

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Abstract

Objectives: The study sought to examine the effect of intravenous iron on heart failure events in hemodialysis patients. Background: Heart failure is a common and deadly complication in patients receiving hemodialysis and is difficult to diagnose and treat. Methods: The study analyzed heart failure events in the PIVOTAL (Proactive IV Iron Therapy in Hemodialysis Patients) trial, which compared intravenous iron administered proactively in a high-dose regimen with a low-dose regimen administered reactively. Heart failure hospitalization was an adjudicated outcome, a component of the primary composite outcome, and a prespecified secondary endpoint in the trial. Results: Overall, 2,141 participants were followed for a median of 2.1 years. A first fatal or nonfatal heart failure event occurred in 51 (4.7%) of 1,093 patients in the high-dose iron group and in 70 (6.7%) of 1,048 patients in the low-dose group (HR: 0.66; 95% CI: 0.46-0.94; P = 0.023). There was a total of 63 heart failure events (including first and recurrent events) in the high-dose iron group and 98 in the low-dose group, giving a rate ratio of 0.59 (95% CI: 0.40-0.87; P = 0.0084). Most patients presented with pulmonary edema and were mainly treated by mechanical removal of fluid. History of heart failure and diabetes were independent predictors of a heart failure event. Cconclusion: Compared with a lower-dose regimen, high-dose intravenous iron decreased the occurrence of first and recurrent heart failure events in patients undergoing hemodialysis, with large relative and absolute risk reductions. (UK Multicentre Open-label Randomised Controlled Trial Of IV Iron Therapy In Incident Haemodialysis Patients; 2013-002267-25).

Item Type:Articles
Additional Information:Supported by Kidney Research UK, which was supported by an unrestricted grant from Vifor Fresenius Medical Care Renal Pharma. MCP and JJMcM are supported by a British Heart Foundation Centre of Research Excellence Grant RE/18/6/34217.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Connolly, Dr Eugene and Robertson, Mrs Michele and Mark, Professor Patrick and Jhund, Dr Pardeep and McMurray, Professor John and Ford, Professor Ian and Petrie, Professor Mark
Authors: Jhund, P. S., Petrie, M. C., Robertson, M., Mark, P. B., MacDonald, M. R., Connolly, E., Anker, S. D., Bhandari, S., Farrington, K., Kalra, P. A., Wheeler, D. C., Tomson, C. R.V., Ford, I., McMurray, J. J.V., and Macdougall, I. C.
Subjects:R Medicine > R Medicine (General)
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
Journal Name:JACC: Heart Failure
Publisher:Elsevier
ISSN:2213-1779
ISSN (Online):2213-1787
Published Online:09 June 2021
Copyright Holders:Copyright © 2021 Elsevier on behalf of the American College of Cardiology Foundation
First Published:First published in JACC: Heart Failure 9(7): 518-527
Publisher Policy:Reproduced in accordance with the publisher copyright policy

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
303944BHF Centre of ExcellenceRhian TouyzBritish Heart Foundation (BHF)RE/18/6/34217CAMS - Cardiovascular Science