The traditional treatment for anemia in patients with CKD is injectable erythropoietin-stimulating agents (ESA). Daprodustat is an oral hypoxia-inducible factor prolyl hydroxylase inhibitor that provides an alternative. Patients who have CKD are at a greater risk of heart failure, but it is unknown whether daprodustat affects the risk of heart failure hospitalization.
Jonathan W. Cunningham, MD, MPH, and other researchers compared daprodustat to ESA in patients with CKD-related anemia who did or did not require dialysis in the ASCEND-D (n=2964) and ASCEND-ND (n=3872) trials, respectively. They identified risk factors for heart failure hospitalization then assessed the effect of daprodustat versus traditional ESA on heart failure hospitalizations. A history of heart failure, diabetes, and higher systolic blood pressure were independently associated with heart failure hospitalization in both trials.
A greater proportion of first heart failure hospitalizations occurred in patients treated with daprodustat compared with ESA. This was true in both the group not receiving dialysis (HR, 1.22 [0.95-1.56]; P=.12] and in those receiving dialysis (HR, 1.10 [0.84-1.45]; P=.47). However, the differences were not statistically significant. HRs in patients with and without a history of heart failure were 1.37 (0.89-2.11) compared with 1.08 (0.79-1.46; P-interaction=.36) in ASCEND-ND and 1.52 (0.97-2.38) versus 0.93 (0.66-1.30; P-interaction=.09) in ASCEND-D, respectively.
In post hoc analyses, daprodustat increased the total number of heart failure hospitalizations in participants not receiving dialysis (rate ratio, 1.46 [1.11-1.92]; P=.007) but not in participants receiving dialysis (rate ratio ,1.01 [0.74–1.39], P=.93). Daprodustat did not significantly influence the risk of a composite outcome of first heart failure hospitalization or death.
© 2025 Mashup Media, LLC, a Formedics Property. All Rights Reserved.