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Войти в исследования Nephrology (Carlton, Vic.) · 2026
Retinal Disease Risk With Hypoxia-Inducible Factor Prolyl Hydroxylase Inhibitors Versus Long-Acting Erythropoiesis-Stimulating Agents in Patients With Non-Dialysis Chronic Kidney Disease: A Real-World Database Analysis in Japan.
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Hoshino Kento, Sasabuchi Yusuke, Miyamoto Yoshihisa, Hashimoto Yohei, Yasunaga Hideo
Аннотация
AIM: Hypoxia-inducible factor prolyl hydroxylase (HIF-PH) inhibitors constitute novel oral pharmacotherapy for anaemia in chronic kidney disease (CKD). Although a possible HIF-PH inhibitor-induced increase in vascular endothelial growth factor could exacerbate retinal diseases, real-world evidence is limited, particularly among Japanese non-dialysis patients.
METHODS: We conducted a retrospective cohort study using the DeSC administrative claims database (DeSC Healthcare Inc., Tokyo, Japan; December 2019 to June 2023). We identified patients with CKD who newly used HIF-PH inhibitors or long-acting erythropoiesis-stimulating agents (ESAs). The primary outcome was the first treatment-requiring retinal disease. We employed the matching weight method using high-dimensional propensity scores to adjust for confounding and inverse probability of censoring weights (IPCW) to account for informative censoring.
RESULTS: The study included 74 530 treatment-naïve patients (mean age: 84.7 years; 49 928 ESA users; 24 602 HIF-PH inhibitor users). The risk of retinal diseases did not differ significantly between the HIF-PH inhibitor and ESA groups. The adjusted hazard ratio (HR) with matching weights was 0.65 [95% confidence interval (CI): 0.37-1.12]. The HR with matching weights and IPCW was 0.55 (95% CI: 0.22-1.38). Sensitivity analyses supported these findings. Negative control analysis using cataracts yielded an adjusted HR of 0.85 (95% CI: 0.67-1.07). Subgroup analyses showed no increased risk across categories.
CONCLUSIONS: HIF-PH inhibitors were not associated with an increased risk of treatment-requiring retinal disease. These real-world data suggest the retinal safety of HIF-PH inhibitors in non-dialysis patients with CKD. Retinal concerns may not necessarily be a limiting factor while selecting HIF-PH inhibitors for non-dialysis patients with CKD.
METHODS: We conducted a retrospective cohort study using the DeSC administrative claims database (DeSC Healthcare Inc., Tokyo, Japan; December 2019 to June 2023). We identified patients with CKD who newly used HIF-PH inhibitors or long-acting erythropoiesis-stimulating agents (ESAs). The primary outcome was the first treatment-requiring retinal disease. We employed the matching weight method using high-dimensional propensity scores to adjust for confounding and inverse probability of censoring weights (IPCW) to account for informative censoring.
RESULTS: The study included 74 530 treatment-naïve patients (mean age: 84.7 years; 49 928 ESA users; 24 602 HIF-PH inhibitor users). The risk of retinal diseases did not differ significantly between the HIF-PH inhibitor and ESA groups. The adjusted hazard ratio (HR) with matching weights was 0.65 [95% confidence interval (CI): 0.37-1.12]. The HR with matching weights and IPCW was 0.55 (95% CI: 0.22-1.38). Sensitivity analyses supported these findings. Negative control analysis using cataracts yielded an adjusted HR of 0.85 (95% CI: 0.67-1.07). Subgroup analyses showed no increased risk across categories.
CONCLUSIONS: HIF-PH inhibitors were not associated with an increased risk of treatment-requiring retinal disease. These real-world data suggest the retinal safety of HIF-PH inhibitors in non-dialysis patients with CKD. Retinal concerns may not necessarily be a limiting factor while selecting HIF-PH inhibitors for non-dialysis patients with CKD.