Keywords: comparative effectiveness research, epidemiology
Hemodialysis patients lose 2-3 grams of iron per year through blood loss. Intravenous (IV) iron is widely used to replace this lost iron; however, questions exist about the safest and most effective method of dosing. We discuss the results of a non-experimental study comparing the short-term effects of bolus versus maintenance dosing of IV iron. In a well-characterized cohort of 117,050 hemodialysis patients, we estimate the effects of the two iron dosing approaches on infection and cardiovascular risk, quality of life, iron status, and hemoglobin. Using inverse-probability weighted estimators of cumulative risk, we find evidence of clinically-meaningful treatment effect heterogeneity. I discuss the implications of these results on patient care and some ongoing research using discrete choice experiments to assess patient preferences regarding outcomes.