A new paper in Cardiovascular Research, published by Oxford University Press, indicates that iron treatments may reduce heart attacks in patients experiencing kidney failure undergoing dialysis.
Coronary artery disease is prevalent in patients with chronic kidney disease but how often heart attacks occur in patients on maintenance hemodialysis and the appropriate treatments to try to prevent heart attacks in such cases is a matter of debate. Observational studies in humans and animal studies lead some researchers to express concern that intravenous iron could increase the prevalence or severity of heart attacks. Others argue that, because iron is likely to result in more oxygen delivery, intravenous iron may reduce coronary events. But there was limited research to support this.
This paper is an analysis of 2141 patients enrolled in the Proactive IV Iron Therapy in Haemodialysis Patients (PIVOTAL) trial, a large-scale controlled experiment at 50 sites in the United Kingdom. The researchers here investigated the effects of high-dose versus low-dose intravenous iron in patients on hemodialysis. They report the rates of heart attacks, types of heart attacks, the prognostic importance of these heart attacks, as well as the effect of high versus low dose iron.
The researchers measured the impact of iron interventions on type 1 heart attacks (the most common type of heart attacks, which results from a blood clot or some other blockage in blood flow) and type 2 heart attacks (which occur without a blockage, in situations where the heart needs more oxygen than it's getting). The researchers found that 8.4% of patients on dialysis had heart attacks over two years. Rates of type 1 heart attacks were 2.5 times higher than type 2 heart attacks.
High dose intravenous iron reduced heart attacks compared to low dose intravenous iron. Heart attacks occurred in 76 of 1093 patients (7%) in the high dose group and 100 of 1048 patients (9.5%) in the low dose group. Type 1 heart attacks occurred in 5.5% of patients in the high dose group and 7.3% in the low dose group. Investigators found no reduction in type 2 heart attacks from intravenous iron intervention.
“Very few therapies investigated in people on dialysis have been shown to improve outcomes," said the paper's lead author, Mark Petrie. "We are delighted that high dose iron given into people veins reduces heart attacks. Our hope that this treatment is used around the world in people with kidney failure on dialysis.”
The paper, “High-dose intravenous iron therapy reduces myocardial infarction in patients on haemodialysis,” is available at https://academic.oup.com/cardiovascres/advance-article/doi/10.1093/cvr/cvab317/6454738.
Direct correspondence to:
British Heart Foundation Cardiovascular Research Centre
University of Glasgow
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Method of Research
Randomized controlled/clinical trial
Subject of Research
High-dose intravenous iron reduces myocardial infarction in patients on haemodialysis
Article Publication Date
M.C.P. reported receiving lecture fees from AstraZeneca, Novartis, and Eli Lilly, grant support, advisory board fees, and fees for serving on an endpoint committee from Boehringer Ingelheim, advisory board fees, lecture fees, and fees for serving on an endpoint committee from Novo Nordisk, advisory board fees from Napp Pharmaceuticals, and fees for serving on an endpoint committee from Takeda Pharmaceutical and Bayer. P.S.J. receiving consulting fees, advisory board fees, and lecture fees from Novartis, advisory board fees from Cytokinetics, and grant support from Boehringer Ingelheim. S.D.A. reported receiving fees for serving on a steering committee for Vifor, Bayer, Boehringer Ingelheim, Novartis, Servier, and grant support from Abbott Vascular. S.B. reported receiving lecture fees from Vifor Pharma and Pharmacosmos. P.A.K. reported receiving grants, personal fees and non-financial support from Vifor Fresenius, personal fees and nonfinancial support from Pharmacosmos. D.C.W. reported receiving personal fees from AstraZeneca, Akebia, Boehringer Ingelheim, Jannsen, Napp, Vifor Fresenius, and Amgen. C.R.V.T. has nothing to disclose. I.F. reported receiving grant support from Kidney Research UK, Vifor Pharma, and Pharmacosmos. J.J.V.Mc.M. reports receiving fees (all fees listed paid to Glasgow University) for serving on a steering committee from Bayer, fees for serving on a steering committee, fees for serving on an endpoint committee, and travel support from Cardiorentis, fees for serving on a steering committee and travel support from Amgen, fees for serving on a steering committee and travel support from Oxford University–Bayer, fees for serving as principal investigator of a trial and travel support from Theracos, fees for serving on a steering committee and travel support from AbbVie, fees for serving on a steering committee from DalCor Pharmaceuticals, fees for serving on a data and safety monitoring committee from Pfizer, fees for serving on a data and safety monitoring committee from Merck, fees for serving on an executive committee, fees for serving as co-principal investigator of a trial, fees for serving on a steering committee, fees for serving on an executive committee, travel support, and advisory board fees from Novartis, fees for serving as co-principal investigator for a trial, fees for serving on a steering committee, and travel support from GlaxoSmithKline, fees for serving on a steering committee from Bristol-Myers Squibb, and fees for serving on a steering committee, fees for serving on an endpoint adjudication committee, and travel support from Vifor Pharma–Fresenius. I.C.M. reported receiving grants from Kidney Research UK, Akebia, Bayer, and Astellas, personal fees from AMAG, FibroGen, Pharmacosmos and Vifor Pharma and grants and personal fees from GlaxoSmithKline.