Hypoxia-inducible factor prolyl hydroxylase inhibitors for anaemia in chronic kidney disease: a clinical practice document by the European Renal Best Practice board of the European Renal Association
A European Renal Best Practice clinical practice document reviews hypoxia-inducible factor prolyl hydroxylase (HIF-PH) inhibitors as an oral alternative to erythropoiesis-stimulating agents for anaemia in CKD, citing proven hemoglobin efficacy across many trials while emphasizing that long-term cardiovascular, thromboembolic, and tumor-growth safety still needs to be fully established.
Background
Anaemia is a common complication of CKD, associated with greater mortality, hospitalization, cardiovascular events, and CKD progression, yet remains undertreated. For three decades, iron, erythropoiesis-stimulating agents (ESAs), and transfusions have been the mainstay; HIF-PH inhibitors offer a novel oral alternative.
Mechanism and efficacy
HIF-PH inhibitors mimic the body's response to hypoxia, stimulating endogenous erythropoietin production. Their efficacy in correcting and maintaining hemoglobin has been demonstrated across more than 30 phase 3 trials. HIF activation also has pleiotropic effects beyond erythropoiesis, including cholesterol reduction, improved iron homeostasis (lower hepcidin, reduced IV iron need), and potential anti-inflammatory effects.
Safety considerations
The long-term safety profile — particularly cardiovascular and thromboembolic events and any effect on tumor growth — has not been fully elucidated and requires careful ongoing evaluation.
Clinical implications
HIF-PH inhibitors are a reasonable oral option for anaemia of CKD, potentially advantageous in inflamed patients and those preferring oral therapy, but the document frames their use according to current evidence and stresses individualized prescribing pending more long-term safety data.
Category
Transplant
Source
Nephrology Dialysis Transplantation
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