Patient characteristics and treatment efficacy after switching to hypoxia-inducible factor-prolyl hydroxylase inhibitors from erythropoiesis-stimulating agents in non-dialysis-dependent chronic kidney disease patients: the Reach-J CKD cohort study.

BACKGROUND

Hypoxia-inducible factor-prolyl hydroxylase inhibitors (HIF-PHIs) are likely to be effective in patients with anemia in chronic kidney disease (CKD) who are resistant to treatment with erythropoiesis-stimulating agents (ESAs). However, few studies assess HIF-PHIs in patients with elevated ERI who do not yet require hemodialysis.

METHODS

This multicenter, prospective, observational study utilized data from the Reach-J study to explore the characteristics of Japanese patients with anemia in CKD (stage G3b-5) who switched from ESAs to HIF-PHIs. We also examined changes in hemoglobin levels following switching.

RESULTS

We assessed 447 patients who continued ESA treatment and 34 patients who switched from ESAs to HIF-PHIs (mean age: 74 years). Patients who switched had numerically higher mean erythropoietin resistance index (ERI) and numerically lower hemoglobin than those who continued ESA treatment. Mean hemoglobin levels increased following switching (9.9 g/dL vs. 10.6 g/dL; p = 0.004). After 3 months, hemoglobin levels increased in both high and low ERI subgroups (high ERI: 9.7 g/dL to 11.1 g/dL, low ERI: 10.6 g/dL to 11.8 g/dL). Hemoglobin levels did not notably decrease before or after the start of hemodialysis in two HIF-PHI-treated patients.

CONCLUSIONS

Patients who switched to HIF-PHIs had low hemoglobin levels and high ERI compared with those who continued ESA treatment. Both high ERI and low ERI groups had increased hemoglobin levels after switching.

TRIAL REGISTRATION: UMIN Clinical Trials Registry (UMIN000022145, registration date: 30 April 2016).