Introduction:
Anemia in chronic kidney disease is a multifactorial disease which significantly affects the quality of life and overall health of patients. It is mainly caused by erythropoietin deficiency, inflammatory process and increase hepcidin leading to impaired absorption of iron for the GI tract, accumulation of uremic toxins and reduced red cell life span. Anemia is diagnosed in adults with CKD when the Hb concentration is <13.0 g/dl in males and <12.0 g/dl in females. Currently, supplemental iron and recombinant human erythropoietin (EPO) consist of majority of the prescriptions for the management of anemia in CKD. Many anaemic chronic kidney disease (CKD) patients are refractory to erythropoietin (EPO) effects due to inflammation, deranged iron utilization, and generation of EPO antibodies. Also, ESAs in CKD anemia treatment has raised safety concerns as greater risk for death, CV events, and stroke. Currently, a new class of drugs called HIF prolyl hydroxylase inhibitors act by stabilizing HIF, which in turn stimulates endogenous erythropoietin production. Also, it has potential to downregulate hepcidin which enhances absorption of iron from small intestine. Additionally, it offers ease of administration over ESAs. Desidustat is one such oral medication which is an emerging therapeutic approach for the management of anemia associated with CKD. Our study is to compare efficacy of desidustat in comparison to erythropoietin in increasing the hemoglobin levels and observe any side effects in both groups.
Methods:
We conducted this prospective, randomized study from October 2022 to April 2024. We included all adult patients of both sexes with chronic kidney disease on maintenance haemodialysis. Their baseline hemoglobin Baseline hemoglobin 8 – 11 g/dL. We excluded patients having history of any malignancy, post renal transplant patient, any patient with bleeding disorder and any of them who received blood transfusion in past 8 weeks. Patients were divided in 1:1 group where first group received Desidustat 50 – 100 mg alternate day depending upon their severity of anemia and other group received erythropoietin stimulating agents (erythropoietin alpha or darbepoetin).
Results:
We conducted this study in 90 patients which were divided in two groups each of 45 patients. We measured hemoglobin in each group at baseline and after 16 weeks. We observed that there was change in hemoglobin from baseline to 16 weeks by 2.1g/dL in patients on desidustat and 2.3 g/dL in group of patients on ESAs. Patients tolerated desidustat well. No major complications were observed in either of groups
Conclusions:
We observed in our study that improvement in hemoglobin in patients on Desidustat was noninferior when compared to those patients on erythropoietin stimulating agents. No any major complications were observed in either of the group
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.