Abstract: SA-PO1185
Effectiveness of Switching from Erythropoiesis-Stimulating Agents to Hypoxia-Inducible Factor-Prolyl Hydroxylase Inhibitors in Nondialysis-Dependent Patients with CKD: Reach-J CKD Cohort Study
Session Information
- CKD: Biomarkers and Emerging Tools for Diagnosis and Monitoring
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Authors
- Yamagata, Kunihiro, Tsukuba Daigaku Igaku Iryokei, Tsukuba, Ibaraki Prefecture, Japan
- Ohigashi, Tomohiro, Tokyo Rika Daigaku, Shinjuku, Tokyo, Japan
- Saito, Chie, Tsukuba Daigaku Igaku Iryokei, Tsukuba, Ibaraki Prefecture, Japan
- Kai, Hirayasu, Tsukuba Daigaku Igaku Iryokei, Tsukuba, Ibaraki Prefecture, Japan
- Tsunoda, Ryoya, Tsukuba Daigaku Igaku Iryokei, Tsukuba, Ibaraki Prefecture, Japan
- Okubo, Reiko, Tsukuba Daigaku Igaku Iryokei, Tsukuba, Ibaraki Prefecture, Japan
- Kondo, Masahide, Tsukuba Daigaku Igaku Iryokei, Tsukuba, Ibaraki Prefecture, Japan
- Ishii, Haruka, Kyowa Kirin Kabushiki Kaisha, Chiyoda, Tokyo, Japan
- Inuzuka, Masami, Kyowa Kirin Kabushiki Kaisha, Chiyoda, Tokyo, Japan
- Harada, Kenji, Kyowa Kirin Kabushiki Kaisha, Chiyoda, Tokyo, Japan
- Narita, Ichiei, Niigata Daigaku, Niigata, Niigata Prefecture, Japan
- Okada, Hirokazu, Saitama Ika Daigaku Igakubu Daigakuin Igaku Kenkyuka, Iruma, Saitama Prefecture, Japan
- Wada, Takashi, Kanazawa Daigaku, Kanazawa, Ishikawa Prefecture, Japan
- Maruyama, Shoichi, Nagoya Daigaku Daigakuin Igakukei Kenkyuka Igakubu, Nagoya, Aichi Prefecture, Japan
- Hoshino, Junichi, Tokyo Joshi Ika Daigaku, Shinjuku, Tokyo, Japan
Background
Anemia of chronic kidney disease (CKD) can be treated with erythropoiesis-stimulating agents (ESAs); however, ESA resistance can occur. Another option is hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs), which have been commercially available in Japan since 2019, but their conditions and effects in clinical settings are largely unknown. We investigated the characteristics of CKD patients switched from ESA to HIF-PHI therapy and examined treatment effects following switching to HIF–PHIs. We also examined whether HIF-PHI can maintain hemoglobin (Hb) levels, which often transiently decline with ESA therapy before and after the start of dialysis.
Methods
Reach-J CKD was an observational, prospective cohort study of patients with CKD (stages G3b–G5) in Japan; those who had received ESA therapy were eligible for the present analysis. Background characteristics of patients who were switched from ESA to HIF-PHI therapy were compared with those of patients who continued ESA therapy. Pre- and post-switch Hb levels and iron-related markers were compared. Continuous variables were compared using Welch’s t-test and a Mann–Whitney U test, and categorical variables using Fisher’s exact test.
Results
Patients switched from ESA to HIF-PHI therapy (n = 34) had significantly higher erythropoietin resistance index (ERI), and lower Hb, Fe, TSAT, serum albumin, than patients who continued ESA therapy (n = 447) (p < 0.05). Three months post switch, Hb (n = 25) and TIBC (n = 11) had increased, and changes in Hb distribution were observed. In patients switched to HIF-PHI therapy, Hb was increased in both high- and low-ERI groups. In two patients switched to HIF-PHI therapy before dialysis, there was no decrease in Hb before and after dialysis.
Conclusion
Patients switched from ESA to HIF-PHI therapy had high ERI and low Hb levels at baseline, and their Hb levels were increased post switch, regardless of baseline ERI. The finding that switching from ESA to HIF-PHI therapy may help maintain Hb levels before and after dialysis warrants further investigation.
Funding
- Commercial Support – Kyowa Kirin Co., Ltd.