A Prospective Randomized Controlled Clinical Study to Investigate the Efficacy and Safety of Hypoxia-Inducible Factor-Prolyl Hydroxylase Inhibitors in Non-Dialysis Patients with Chronic Heart Failure and Renal Anemia Switched from Continuous Erythropoietin Receptor Activator Treatment
In patients with chronic heart failure and renal anemia switched from a continuous erythropoietin receptor activator to one of four HIF-PH inhibitors, hemoglobin control was broadly similar to continued ESA therapy, though roxadustat outperformed vadadustat and daprodustat on hemoglobin at 6 months in this small trial.
Background
CKD and anemia both independently worsen heart failure prognosis; HIF-PH inhibitors are an emerging oral alternative to erythropoiesis-stimulating agents for renal anemia.
Study design
Forty non-dialysis patients with chronic heart failure and renal anemia on a continuous erythropoietin receptor activator (CERA) were randomized to switch to roxadustat, daprodustat, vadadustat, or molidustat, with hemoglobin as the primary endpoint over 6 months.
Key findings
No significant overall difference in hemoglobin was seen for HIF-PHIs versus continued CERA, but at month 6 roxadustat produced higher hemoglobin than vadadustat or daprodustat; erythropoietin fell after switching, and thyroid hormone levels were variably affected.
Safety
No adverse events were reported in this small trial, though some drug doses required adjustment; the authors caution that the single-center design and limited sample size constrain generalizability.
Category
Research
Source
Journal of Clinical Medicine
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