Real-World Experience of Hypoxia-Inducing Factor-Prolyl Hydroxylase Inhibitor Desidustat for Anemia in Dialysis-Dependent CKD

Background: Anemia poses a significant challenge in the management of End-stage kidney disease (ESKD), leading to a diminished quality of life in affected individuals. Patients with ESKD have a relative deficiency of Eryhtopoetin (EpO) andErythropoetin analogues are a standard of care for such patients. Desidustat is a of Hypoxia Inducing Factor Prolyl Hydroxylase Inhibitor (HIF –PHI) thatendogenously increases the EpO production. We studied the real world effectiveness of Desidustat, in ameliorating anemia among ESKD patients undergoing maintenance hemodialysis. Methods: Observational cohort data were collected data of 65 ESKD patients, aged >18 years on maintenance hemodialysis with hemoglobin levels <10g/dL. Patients with iron deficiency anemia, known bleeding disorders, recent red blood cell transfusions, or concurrent cancer were excluded. Initially, all patients received 100 mg of Desidustat thrice weekly, with subsequent dose adjustments based on individual responses. Results: The patients had a mean age of 50.35±12.94 years with 45 being male. Of all patients, 41 (63%) were EpO naïve and others were switched from EpO. After 3 months, only 6 patients exhibited a positive response to the initial Desidustat regimen, necessitating a dose escalation to 150 mg. thrice weekly. Following this , 47 out of 65 patients showed significant improvements in hemoglobin levels after 3 months. However, 18 patients (27.6%) did not respond to Desidustat treatment. The mean hemoglobin level before Desidustat initiation was 8.13±0.77 g/dl and after 24 weeks of Desidustat therapy, the mean hemoglobin level rose to 8.73±0.97 g/dl, with a statistically significant p-value of <0.001. There were no major adverse events during the follow-up duration. Conclusion: Desidustat demonstrated effectiveness in increasing Hb levels in around 3/4th of ESKD patients undergoing MHD. However, starting at 150mg thrice weekly seems to be more beneficial in our population