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During the congress, E-Posters will be accessible to all participants on the congress website 24/7, as well as in the E-poster stations in the congress center.
Preparing your E-Poster
Please review the E-Poster format requirements carefully when preparing your E-Poster. Should your E-Poster not meet the mentioned requirements, it may not be displayed as described above.
E-Poster Submission Deadline
Please prepare and upload your E-Poster no later than March 14, 2026 11.59PM CET. After this date, you will no longer be able to prepare and upload your E-poster and it will not be displayed and accessible on the congress website.
Please follow the instructions below to input your abstract title.
Abstract titles should be brief and reflect the content of the abstract.
Anemia is a common complication of chronic kidney disease (CKD) and contributes to the progression of both CKD and heart failure. Although current guidelines recommend maintaining hemoglobin (Hb) within the target range, Hb levels often decline progressively under uremic conditions in advanced CKD. In Japan, five hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs) have been approved since 2021, expanding therapeutic options for anemia management. HIF-PHIs are expected to enhance iron utilization and may be effective in patients with hyporesponsiveness to erythropoiesis-stimulating agents (ESAs). We evaluated real-world anemia management in patients prior to hemodialysis (HD) initiation.
We retrospectively analyzed patients who initiated HD between 2023 and 2024 across four general hospitals in Japan. Patients with malignancy, active inflammatory disease, or recent blood transfusion during the preceding 6 months were excluded. Changes in Hb levels and the use of anemia therapies during the 6 months before HD initiation were evaluated.
Among 206 screened patients, 91 were excluded (late referral 38, acute kidney injury 7, transition from peritoneal dialysis 3, malignancy 11, inflammatory disease 4, transfusion 5, other reasons 15, missing data 8). The final cohort included 115 patients (mean age 72 ± 13 years, 62% male, BMI 24 ± 5 kg/m²). Mean eGFR declined from 10.3 ± 3.9 to 6.3 ± 2.1 mL/min/1.73 m² over 6 months. The primary causes of CKD were diabetic kidney disease (36%), nephrosclerosis (29%), and glomerulonephritis (11%). ESA was used in 60%, HIF-PHIs in 30%, and no erythropoietic agents in 10%, with the following distribution: darbepoetin alfa 34%, epoetin beta pegol 26%, daprodustat 25%, roxadustat 3%, vadadustat 1%, and enarodustat 1%. Iron supplementation was prescribed in 19%. Mean Hb decreased from 10.8 ± 1.2 to 9.6 ± 1.4 g/dL; 61% of patients had Hb < 10 g/dL and 33% had Hb < 9 g/dL at HD initiation. Among the 38 patients with Hb < 9 g/dL, 12 had insufficient dose escalation of erythropoietic agents, whereas 26 experienced a rapid Hb decline at the final visit despite ongoing treatment. In a multivariate logistic regression model adjusted for sex, age, and transferrin saturation, lower Hb 6 months prior was independently associated with Hb < 9 g/dL at HD initiation (p < 0.001), without significant differences between ESA and HIF-PHI groups.
Despite contemporary anemia therapy, 60% of patients presented with Hb < 10 g/dL and one-third with Hb < 9 g/dL at HD initiation. Lower baseline Hb strongly predicted suboptimal Hb control, suggesting that earlier dose adjustment and closer monitoring are warranted during progression to end-stage kidney disease.
