BMC nephrology · 2026
Real-world use of HIF-PH inhibitors in the Japan dialysis and practice patterns study (J-DOPPS, 2019-2022).
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Eriguchi Masahiro, Tsuruya Kazuhiko, Noma Hisashi, Onishi Yoshihiro, Inuzuka Masami, Harada Kenji, Nangaku Masaomi
Аннотация
BACKGROUND: Hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs) are a novel therapeutic alternative to erythropoiesis-stimulating agents (ESAs) for anemia in chronic kidney disease. Evidence regarding their real-world effectiveness is still limited.
METHODS: We analyzed data from the Japanese Dialysis Outcomes and Practice Patterns Study (J-DOPPS, 2019–2022) to assess the real-world effectiveness of HIF-PHIs among maintenance hemodialysis patients. We compared patients who transitioned from ESAs to HIF-PHIs with those who continued ESAs, focusing on baseline characteristics and changes in anemia-related, iron metabolism, and inflammatory parameters.
RESULTS: Among 1433 patients on ESAs, only 56 (3.9%) were switched to HIF-PHIs. Compared with the ESA continuation group, patients in the HIF-PHI group had poorer nutritional status (albumin: 3.3 vs. 3.6 g/dL; cholesterol: 142 vs. 156 mg/dL; respectively) and greater ESA resistance (erythropoietin resistance index: 18.4 vs. 8.5 IU/kg/week/g/dL, respectively), despite higher ESA doses and iron prescription rates. After switching, a significant increase in hemoglobin was observed at 1 month (+0.44 g/dL; 95% confidence interval: 0.05–0.82; p = 0.025). Serum iron and total iron-binding capacity levels also increased, while transferrin saturation and ferritin remained unchanged. A subgroup analysis suggested greater hemoglobin response in patients with high C-reactive protein levels (p for interaction = 0.074), but no difference by erythropoietin resistance index (p for interaction = 0.372).
CONCLUSIONS: In routine clinical practice, HIF-PHIs were selectively prescribed to patients with treatment-refractory anemia. Treatment increased hemoglobin levels, with a suggestive trend toward greater effect among those with inflammation, supporting the potential utility of HIF-PHIs in complex anemia management.
SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12882-026-04831-2.
METHODS: We analyzed data from the Japanese Dialysis Outcomes and Practice Patterns Study (J-DOPPS, 2019–2022) to assess the real-world effectiveness of HIF-PHIs among maintenance hemodialysis patients. We compared patients who transitioned from ESAs to HIF-PHIs with those who continued ESAs, focusing on baseline characteristics and changes in anemia-related, iron metabolism, and inflammatory parameters.
RESULTS: Among 1433 patients on ESAs, only 56 (3.9%) were switched to HIF-PHIs. Compared with the ESA continuation group, patients in the HIF-PHI group had poorer nutritional status (albumin: 3.3 vs. 3.6 g/dL; cholesterol: 142 vs. 156 mg/dL; respectively) and greater ESA resistance (erythropoietin resistance index: 18.4 vs. 8.5 IU/kg/week/g/dL, respectively), despite higher ESA doses and iron prescription rates. After switching, a significant increase in hemoglobin was observed at 1 month (+0.44 g/dL; 95% confidence interval: 0.05–0.82; p = 0.025). Serum iron and total iron-binding capacity levels also increased, while transferrin saturation and ferritin remained unchanged. A subgroup analysis suggested greater hemoglobin response in patients with high C-reactive protein levels (p for interaction = 0.074), but no difference by erythropoietin resistance index (p for interaction = 0.372).
CONCLUSIONS: In routine clinical practice, HIF-PHIs were selectively prescribed to patients with treatment-refractory anemia. Treatment increased hemoglobin levels, with a suggestive trend toward greater effect among those with inflammation, supporting the potential utility of HIF-PHIs in complex anemia management.
SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12882-026-04831-2.