Short-term impact of switching from erythropoiesis-stimulating agents and roxadustat to daprodustat among patients undergoing hemodialysis

Daprodustat is a novel oral agent for renal anemia. This retrospective study examined 124 maintenance patients undergoing HD who had shifted from erythropoiesis-stimulating agents (ESA) or roxadustat to daprodustat (4mg daily). Anemia control, iron metabolism markers, and doses of daprodustat within 3 months after the shifting therapies were assessed. We used multivariate logistic regression analysis to determine the factors associated with the use of high doses of daprodustat 3 months after. The serum hemoglobin level significantly decreased after shifting therapies. Similarly, the proportion of patients who achieving a hemoglobin level within the appropriate range was also significantly lower, and median doses of daprodustat gradually increased. A significant increase in the serum iron, total iron-binding capacity, and transferrin saturation levels were found, but the serum ferritin level did not differ during the study period. Multivariate regression analysis showed that diabetes, a low Hb level, and use of high doses of ESA/roxadustat were independent predictors for the use of high doses of daprodustat 3 months after shifting therapies. We concluded that renal anemia control may worsen after shifting to daprodustat. Patients with diabetes, a low Hb level at baseline, and those receiving high doses of ESA/roxadustat may require high doses of daprodustat.