DESIDUSTAT IN ERYHTROPOETIN INDUCED PURE RED CELL APLASIA IN DIALYSIS-DEPENDENT CKD PATIENTS: A CASE REPORT

Introduction:

Pure red cell aplasia (PRCA) is a disorder, which leads to severe anemia due to suppression of erythropoiesis. PRCA may develop in response to antibodies against rHuEPO in patients with chronic kidney disease (CKD). Current management strategies for PRCA include discontinuation of erythropoiesis-stimulating agents (ESAs) like Eryhthropoetin and the initiation of immunosuppressive agents.

Methods:

This is a single center retrospective case report of 77 year old male suffering from chronic kidney disease. The patient received erythropoetin (10000 IU/week) for treatment of CKD-Anemia. Going forward he was diagnosed with Erythropoetin induced PRCA. Following which he was given Desidustat (Oxemia®) and followed up for Hb response.

Results:

A 77-year-old male with CKD, was initiated on erythropoietin in 10,000 IU/week for anemia of CKD (Hb 6.5 g/dL). Despite initial improvement, there is a drop in Hb levels, required packed cell transfusions. In October 2021, hemodialysis started 3/weekly, but his Hb remained unresponsive to therapy. In November 2021, the patient was hospitalized with severe anemia (Hb 5 g/dL), low reticulocyte count (0.2%), and on detailed investigation of Bone marrow biopsy diagnosed with pure red cell aplasia (PRCA). Erythropoietin was discontinued, and the patient was started on prednisolone (60 mg twice daily), which was tapered, due to inadequate response, Tacrolimus (1 mg BD, increased to 2 mg) was added. Despite of Oral immunosuppressive interventions, the patient required weekly transfusions. In May 2022, Desidustat a Hypoxia inducing factor prolyl hydroxylase inhibitor (100 mg every other day) was Started. The patient’s Hb levels increased from 8.9 g/dL to 14 g/dL over three months, eliminating the need for transfusions. The patient continues on Desidustat (50 mg every other day) and maintenance dialysis.

Conclusions:

Desidustat may serve as an effective alternative therapy for managing EpO-induced (exogenous) PRCA in CKD patients, offering endogenous EpO production via HIF-PHI pathway. This shows efficacy of Desidustat in challenging cases of CKD-Anemia.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.