• About
  • Masthead
  • License Content
  • Advertise
  • Submit Press Release
  • RSS/Email List
  • Write for us
  • Contact us
2 Minute Medicine
No Result
View All Result

No products in the cart.

SUBSCRIBE
  • Specialties
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • The Scan
  • Wellness
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • AccountLog-in/out
    • Subscribe
    • Sign-in
    • My account
2 Minute Medicine
  • Specialties
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • The Scan
  • Wellness
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • AccountLog-in/out
    • Subscribe
    • Sign-in
    • My account
SUBSCRIBE
2 Minute Medicine
Subscribe
Home All Specialties Chronic Disease

The PIVOTOL trial: high-dose iron reduces incidence of serious adverse events in hemodialysis patients

byDayton McMillan
February 1, 2019
in Chronic Disease, Nephrology
Reading Time: 2 mins read
0
Share on FacebookShare on Twitter

1. Patients undergoing maintenance hemodialysis experienced fewer serious adverse events if treated proactively with high-dose intravenous iron sucrose compared to patients reactively treated with low-dose iron sucrose.

2. Higher doses of erythropoiesis-stimulating agents were utilized more in the low-dose iron group compared to the high-dose group.

Evidence Rating Level: 1 (Excellent)      

Study Rundown: Maintenance hemodialysis increases blood loss and reduces iron absorption, putting patients at risk for anemia. Intravenous iron administration is now utilized to counteract iron loss in hemodialysis patients, though what dose is optimal is presently unknown. The Proactive IV Iron Therapy in Haemodialysis Patients (PIVOTOL) trial sought to determine if proactive high-dose or reactive low-dose iron therapy would be safer in terms of minimizing serious adverse events, with results indicating patients in the high-dose group experienced fewer major adverse events. Additionally, erythropoiesis-stimulating agents were utilized less in the high-dose group, and infection rates were similar between groups.

This large randomized trial provides substantial evidence for supporting an optimal-dose treatment regimen involving important aspects of both safety and efficacy of iron treatment for hemodialysis patients. Its open-label design and lack of more dosing levels limits its results, though the long-term follow-up is a substantial strength.

Click to read the study in NEJM

Relevant Reading: Considerations and challenges in defining optimal iron utilization in hemodialysis

RELATED REPORTS

Empagliflozin use is associated with slower progression of chronic kidney disease

Ferric derisomaltose may reduce heart failure-related hospitalizations

Personalized cooler dialysate does not reduce cardiovascular events for hemodialysis patients

In-Depth [randomized controlled trial]: This open-label randomized controlled trial enrolled patients at multiple sites in the United Kingdom between 2013 and 2018. Eligible patients had end-stage kidney disease requiring maintenance hemodialysis which was initiated no more than 12 months prior to randomization and also had low ferritin and transferrin saturation levels. Patients were randomized to either proactive high-dose iron sucrose therapy (n=1093) or a reactive low-dose iron sucrose group (n=1048). Ferritin and transferrin saturation values were measured, which guided the iron doses received in both groups. Patients were also given erythropoiesis-stimulating agents as clinically directed to maintain a hemoglobin level within a prespecified target range. The primary endpoint of the trial, a composite outcome of myocardial infarction, stroke, hospitalization due to heart failure, and death, occurred in 29.3% of high-dose and 32.3% of low-dose patients (hazard ratio [HR], 0.85; 95% confidence interval [CI], 0.73 to 1.00; P<0.001 for noninferiority; P=0.04 for superiority) after a median follow-up of 2.1 years. With subgroup analysis, high-dose iron therapy was beneficial for all prespecified groups. Rates of hospitalization or infection were both similar between both groups. The median monthly dose of erythropoiesis-stimulating agent was significantly lower in the high-dose group (median difference, −7539 IU; 95% CI, −9485 to −5582). Serious adverse events occurred in 64.9% and 64.0% of patients in the high- and low-dose groups, respectively.

Image: PD

©2019 2 Minute Medicine, Inc. All rights reserved. No works may be reproduced without expressed written consent from 2 Minute Medicine, Inc. Inquire about licensing here. No article should be construed as medical advice and is not intended as such by the authors or by 2 Minute Medicine, Inc

Tags: dialysisEnd-Stage Renal Diseaseiron
Previous Post

The OVIVA trial: oral antibiotics noninferior to intravenous antibiotics for bone and joint infections

Next Post

Quick Take: Comparative effectiveness of rituximab, abatacept, and tocilizumab in adults with rheumatoid arthritis and inadequate response to TNF inhibitors: prospective cohort study

RelatedReports

Fish oil and aspirin did not reduce arteriovenous fistula failure: The FAVOURED trail
Cardiology

Empagliflozin use is associated with slower progression of chronic kidney disease

January 26, 2023
No association found between length of storage for transfused red blood cells and patient mortality
Cardiology

Ferric derisomaltose may reduce heart failure-related hospitalizations

December 27, 2022
Fish oil and aspirin did not reduce arteriovenous fistula failure: The FAVOURED trail
Cardiology

Personalized cooler dialysate does not reduce cardiovascular events for hemodialysis patients

November 23, 2022
The ABCD2 score: Risk of stroke after Transient Ischemic Attack (TIA) [Classics Series]
Nephrology Classics

The CREDENCE trial: The effect of canagliflozin on renal function [Classics Series]

September 6, 2022
Next Post
Quick Take: Comparative effectiveness of rituximab, abatacept, and tocilizumab in adults with rheumatoid arthritis and inadequate response to TNF inhibitors: prospective cohort study

Quick Take: Comparative effectiveness of rituximab, abatacept, and tocilizumab in adults with rheumatoid arthritis and inadequate response to TNF inhibitors: prospective cohort study

High schoolers use e-cigarettes to vaporize cannabis

E-cigarettes more effective for smoking cessation than nicotine-replacement therapy

Quick Take: Association of maternal probiotic supplementation with human milk oligosaccharide composition

Quick Take: Association of maternal probiotic supplementation with human milk oligosaccharide composition

License Our Award-Winning Physician-Written Medical News and Visual Abstracts

2 Minute Medicine is the leading authoritative medical news licensing service, and the only with reports written by practicing doctors.

LICENSE CONTENT

2MM+ Premium Access

No ads & unlimited access to all current reports, over 9000 searchable archived reports, visual abstracts, Weekly Rewinds, and the online edition of The Classics Series™ textbook.

Subscription Options
2 Minute Medicine

2 Minute Medicine® is an award winning, physician-run, expert medical media company. Our content is curated, written and edited by practicing health professionals who have clinical and scientific expertise in their field of reporting. Our editorial management team is comprised of highly-trained MD physicians. Join numerous brands, companies, and hospitals who trust our licensed content.

Recent Reports

  • Wellness Check: Mental Health
  • SAR-CoV-2 infection during pregnancy may lead to adverse neurodevelopmental outcomes in male offspring
  • Hyperfractionated radiotherapy reduces complication rates compared to standard fractionation for locally advanced nasopharyngeal carcinoma
License Content
Terms of Use | Disclaimer
Cookie Policy
Privacy Statement (EU)
Disclaimer

© 2021 2 Minute Medicine, Inc. - Physician-written medical news.

  • Specialties
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • The Scan
  • Wellness
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • Account
    • Subscribe
    • Sign-in
    • My account

© 2021 2 Minute Medicine, Inc. - Physician-written medical news.

Want more physician-written
medical news?

Join over 10 million yearly readers and numerous companies. For healthcare professionals
and the public.

Subscribe for free today!

Subscription options