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Lynda Szczech

To boldly restate the obvious, trials in anemia have provided surprising, controversial, and dramatic, practice-changing results for the last 20 years. The latest key trial to add to our knowledge on how to treat the anemia of kidney disease is the PIVOTAL trial (1).

The PIVOTAL trial compared higher-dose, proactive IV iron (400 mg monthly) to lower-dose, reactive iron (0 to 400 mg if ferritin <200 μg/L or TSAT <20%) on the risk of the composite endpoint of death, myocardial infarction, stroke, and congestive heart failure. The higher dose proactive arm was found to have a (first) non-inferior