Efficacy and Safety of Desidustat Versus Erythropoietin in Post Kidney Transplant Anaemia: A Prospective Observational Study

AIM: Post-renal transplant anaemia significantly impacts patient outcomes and quality of life. The only option available until recently was erythropoietin (EPO) that requires intravenous or subcutaneous injection. New class of drugs that are hypoxia-inducible factor prolyl hydroxylase inhibitor (HIF-PHI) (desidustat) have become available and there is scarce data on their use in kidney transplant recipients (KTRs). METHODS: This was a prospective observational study which included 58 renal transplant recipients with anaemia (Hb < 10 g/dL) who were started on either oral HIF-PHI in the form of desidustat (n = 30) or EPO (n = 28) based on nephrologist discretion. Adult KTRs with a haemoglobin (Hb) level of less than 10 g/dL were included. Patients with acute graft dysfunction, bleeding and primary haematological diseases were excluded. Baseline clinical characteristics were recorded. Primary outcomes were change in Hb at 8 weeks in the two groups. Secondary outcomes included inflammatory markers (CRP, ESR), iron indices and safety. RESULTS: Both desidustat and erythropoietin groups showed significant improvement in Hb from baseline to 2 months (desidustat: 8.69 ± 0.86 to 9.89 ± 0.92 g/dL; EPO: 8.54 ± 0.73 to 9.55 ± 0.71 g/dL; p > 0.05). No significant differences were observed in inflammatory markers or iron indices. Both treatments were well-tolerated, with no reported adverse events. CONCLUSION: Treatment with desidustat resulted in improvement in haemoglobin levels with acceptable tolerability over short-term follow-up similar to erythropoietin. The convenience of oral administration supports its potential role as a patient-centred option for anaemia management following kidney transplantation.