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).