ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005


The Latest on X

Kidney Week

Please note that you are viewing an archived section from 2023 and some content may be unavailable. To unlock all content for 2023, please visit the archives.

Abstract: TH-PO975

A Regional Perspective of Hypoxia-Inducible Factor-Prolyl Hydroxylase (HIF-PH) Inhibitors in Dialysis

Session Information

Category: Anemia and Iron Metabolism

  • 200 Anemia and Iron Metabolism


  • Weiss, Meghan, Spherix Global Insights, Exton, Pennsylvania, United States
  • Dudzenski, Chris, Spherix Global Insights, Exton, Pennsylvania, United States
  • Regan, Stephen, Spherix Global Insights, Exton, Pennsylvania, United States

Hypoxia-inducible factor prolyl hydroxylase enzyme inhibitors (HIF-PHI) were developed as an alternative to erythropoiesis-stimulating agents (ESA) to treat anemia in chronic kidney disease (CKD) patients. As of fielding, daprodustat was the only approved HIF-PHI in the United States (US) and roxadustat and vadadustat were approved in the European Union (EU); all agents are indicated to treat dialysis patients, while only roxadustat is approved to treat CKD non-dialysis patients in the EU. This analysis of nephrologist attitudes provides insight into regional perceptions of HIF-PHIs as a treatment option for dialysis patients.


Responses were collected via online surveys with 207 US-based nephrologists (February 2023) and 208 EU-based nephrologists (March through April 2023). Additional insights were captured via an independent, retrospective chart audit of 1,282 CKD non-dialysis patient records collected from 263 EU-based nephrologists (December 2021 through February 2022). EU countries surveyed included the UK, Germany, Italy, France, and Spain.


To date, roxadustat has experienced slow uptake among EU nephrologists, with physicians reporting that 6% of their HD patients and 8% of their PD patients are currently on therapy. In the CKD non-dialysis setting, audited patient records reveal that roxadustat treatment rates are even lower at 3.5%, with increased use as patients progress in their CKD.

As of fielding in the US, daprodustat had not been officially launched; however, 52% of physicians report that they are likely to be more reserved and selective in their prescribing once it is available, relying heavily on peers and KOLs for guidance. US physicians also expect that availability and dialysis center protocols will be key drivers of adoption.

Looking towards future use, 55% of EU nephrologists report that the advantages of roxadustat outweigh the potential risks in dialysis patients, compared to 44% of US physicians believing the same for daprodustat. Most nephrologists across regions (70% EU, 55% US) indicate they are anxious to gain clinical experience with the drugs.


Despite recognition of the benefits of HIF-PHIs in dialysis patients, slow adoption of roxadustat in the EU and hesitancy among US-based nephrologists to prescribe daprodustat may stifle treatment evolution in the anemia space, with ESAs likely to remain the standard of care in the dialysis setting.