Longer-Term Results With HIF-PHi for Post-Kidney-Transplant Anemia

Masatomo Ogata, MD, and colleagues previously reported results of a study examining the short-term efficacy of hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHi) for the treatment of post-kidney-transplant anemia. During a poster session at the American Society of Nephrology Kidney Week 2022, they presented results of re-analyzation of HIF-Phi for posttransplant anemia in the context of longer follow-up using a different class of HIF-PHi.

The poster was titled Hypoxia-Inducible Factor Prolyl Hydroxylase Inhibitors for Treatment of Post Kidney Transplant Anemia.

The current analysis included nine kidney transplant recipients at Marianna University School of Medicine, Kawasaki, Japan. In erythropoiesis-stimulating agent (ESA) naïve patients, the indication of HIF-Phi was hemoglobin level below 11.0 g/dL; among patients treated with an ESA, the indication was hemoglobin level below 13.0 g/dL. Either roxadustat or enarodustat was used according to the recommended dose adjustments to achieve target hemoglobin levels between 11.0 and 13.0 g/dL.

Patients were monitored for anemia-related parameters, including hemoglobin, total iron-binding capacity, and ferritin levels, in addition to low-density lipoprotein (LDL) cholesterol up to 14 months. Adverse events of interest were thromboembolic events and malignancy.

Of the nine kidney transplant recipients, six were prescribed roxadustat and three were prescribed enarodustat. Mean estimated glomerular filtration rate in the total cohort was 25.6 mL/min/1.73 m². Most of the transplant recipients showed an increase or maintained their hemoglobin levels from baseline; two kept their hemoglobin levels below the target range.

A few of the transplant recipients treated with roxadustat showed rapid increase and decrease in hemoglobin and ferritin levels, respectively, despite being prescribed the recommended initial dose. Only those in the roxadustat group had a drop in LDL cholesterol levels. There were no adverse events reported during the observation period.

“Based on the recommended dose of HIF-PHi, treatment with roxadustat resulted in a more rapid increase in hemoglobin levels along with a stronger improvement in iron utilization as compared to that seen in treatment with enarodustat,” the researchers said. “For posttransplant anemia, HIF-PHi would be safe and useful in clinical use.”

Source: Ogata M, Miyauchi T, Murata M, et al. Hypoxia-inducible factor prolyl hydroxylase inhibitors for treatment of post kidney transplant anemia. FR-PO832. Abstract of a poster presented at the American Society of Nephrology Kidney Week 2022; November 4, 2022; Orlando, Florida.