The PIVOTAL trial shows that proactive intravenous (i.v.) iron administration reduces cardiovascular events and deaths, transfusions and erythropoiesis-stimulating agent doses and does not increase infections in patients on haemodialysis. These findings upend the warnings of guidelines and experts about the dangers of i.v. iron and prove that maintaining low iron stores is harmful.
This is a preview of subscription content, access via your institution
Access options
Access Nature and 54 other Nature Portfolio journals
Get Nature+, our best-value online-access subscription
$29.99 / 30 days
cancel any time
Subscribe to this journal
Receive 12 print issues and online access
$209.00 per year
only $17.42 per issue
Rent or buy this article
Prices vary by article type
from$1.95
to$39.95
Prices may be subject to local taxes which are calculated during checkout
References
Coyne, D. W. et al. Ferric gluconate is highly efficacious in anemic hemodialysis patients with high serum ferritin and low transferrin saturation: results of the Dialysis Patients’ Response to IV Iron with Elevated Ferritin (DRIVE) Study. J. Am. Soc. Nephrol. 18, 975–984 (2007).
Kapoian, T. et al. Ferric gluconate reduces epoetin requirements in hemodialysis patients with elevated ferritin. J. Am. Soc. Nephrol. 19, 372–379 (2008).
Rostoker, G., Vaziri, N. D. & Fishbane, S. Iatrogenic iron overload in dialysis patients at the beginning of the 21st century. Drugs 76, 741–757 (2016).
KDOQI & National Kidney Foundation. KDOQI clinical practice guidelines and clinical practice recommendations for anemia in chronic kidney disease. Am. J. Kidney Dis. 47, S11–145 (2006).
Besarab, A. et al. The effects of normal as compared with low hematocrit values in patients with cardiac disease who are receiving hemodialysis and epoetin. N. Engl. J. Med. 339, 584–590 (1998).
Singh, A. K. et al. Correction of anemia with epoetin alfa in chronic kidney disease. N. Engl. J. Med. 355, 2085–2098 (2006).
Macdougall, I. C. et al. Intravenous iron in patients undergoing maintenance hemodialysis. N. Engl. J. Med. 380, 447–458 (2019).
Coyne, D. W. The health-related quality of life was not improved by targeting higher hemoglobin in the Normal Hematocrit Trial. Kidney Int. 82, 235–241 (2012).
Amgen Inc. ARANESP® (darbepoetin alfa) [package insert]. Amgen https://www.pi.amgen.com/~/media/amgen/repositorysites/pi-amgen-com/aranesp/ckd/aranesp_pi_hcp_english.pdf (2018).
Anker, S. D. et al. Effects of ferric carboxymaltose on hospitalisations and mortality rates in iron-deficient heart failure patients: an individual patient data meta-analysis. Eur. J. Heart Fail. 20, 125–133 (2018).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
D.W.C. is or has been a consultant to Vifor, Fibrogen, GlaxoSmithKline, Fresenius Medical Care Renal Therapies Group (FMC-RTG), Medibeacon and Reata. He is a speaker for FMC-RTG.
Rights and permissions
About this article
Cite this article
Coyne, D.W. PIVOTAL trial: iron loading improves clinical outcomes. Nat Rev Nephrol 15, 260–261 (2019). https://doi.org/10.1038/s41581-019-0128-5
Published:
Issue Date:
DOI: https://doi.org/10.1038/s41581-019-0128-5