Introduction:
Anemia is a prevalent complication in patients with chronic kidney disease (CKD), significantly impacting their quality of life and clinical outcomes. Erythropoiesis-stimulating agents (ESAs) like Erythropoietin have long been the standard treatment; however, newer agents such as Desidustat, a hypoxia-inducible factor prolyl hydroxylase inhibitor (HIF-PHI), offer potential advantages in efficacy and cost-effectiveness. This study compares the efficacy, safety, and cost-effectiveness of Desidustat versus Erythropoietin in CKD patients undergoing hemodialysis.
Methods:
This was a single-center, prospective, open-label, parallel-group study conducted at Saveetha Institute of Medical Sciences, Chennai. A total of 60 patients with CKD on maintenance hemodialysis were randomized to receive either Desidustat (100 mg orally, thrice a week) or Erythropoietin (subcutaneous injections) for 12 weeks. Hemoglobin levels, biomarkers (TSAT, ferritin, hepcidin), and quality of life were assessed at baseline, 4 weeks, 8 weeks, and 12 weeks. The primary outcome was the proportion of hemoglobin responders (defined as an increase of ≥1 g/dL from baseline). Secondary outcomes included predictors of hemoglobin response, adverse effects, and cost-effectiveness.
Results:
The proportion of hemoglobin responders was 83.33% in the Desidustat group and 73.33% in the Erythropoietin group (p=0.530), indicating no significant difference in efficacy. Hemoglobin levels increased gradually in both groups over 12 weeks. Higher serum albumin (OR = 3.32, 95% CI: 1.54–7.16, p=0.008) and lower iPTH levels (OR = 0.98, 95% CI: 0.97–0.99, p=0.004) were significant predictors of hemoglobin response. Hepcidin levels decreased significantly in the Desidustat group compared to Erythropoietin (p=0.038), suggesting improved iron metabolism with Desidustat. No significant differences were observed in TSAT or ferritin levels. Adverse effects were comparable between the groups, with similar hospitalization and infection rates. Desidustat demonstrated better cost-effectiveness, with a lower monthly cost compared to Erythropoietin
Conclusions:
Desidustat is an effective and safe alternative to Erythropoietin for the treatment of anemia in CKD patients undergoing hemodialysis, with the added advantage of cost-effectiveness. Serum albumin and iPTH were significant predictors of hemoglobin response. Further studies are warranted to confirm these findings in larger and more diverse populations.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.