Kidney Week

Abstract: FR-PO832

Hypoxia-Inducible Factor Prolyl Hydroxylase Inhibitors for Treatment of Post Kidney Transplant Anemia

Session Information

• Transplantation: Clinical - Outcomes
  November 04, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 2002 Transplantation: Clinical

Authors

• Ogata, Masatomo, St. Marianna University School of Medicine, Kawasaki, Japan

Masatomo Ogata,

• Miyauchi, Takamasa, St. Marianna University School of Medicine, Kawasaki, Japan

Takamasa Miyauchi,

• Murata, Marie, St. Marianna University School of Medicine, Kawasaki, Japan

Marie Murata,

• Terashita, Maho, St. Marianna University School of Medicine, Kawasaki, Japan

Maho Terashita,

• Osako, Kiyomi, St. Marianna University School of Medicine, Kawasaki, Japan

Kiyomi Osako,

• Shinoda, Kazunobu, St. Marianna University School of Medicine, Kawasaki, Japan

Kazunobu Shinoda,

• Shibagaki, Yugo, St. Marianna University School of Medicine, Kawasaki, Japan

Yugo Shibagaki,

• Yazawa, Masahiko, St. Marianna University School of Medicine, Kawasaki, Japan

Masahiko Yazawa,

Background

We previously reported the short-term efficacy of hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHi) for the treatment of post kidney transplant anemia (PTA). The present report re-analyzes our experience with HIF-PHi for PTA in the context of longer follow-ups and using a different class of HIF-PHi.

Methods

Nine kidney transplant recipients (KTRs) in our institute who were administered HIF-PHi for PTA were evaluated. The indication of HIF-PHi to erythropoiesis-stimulating agent (ESA) naive patients was an hemoglobin (Hb) level below 11.0 g/dL, and to ESA treated patients was an Hb level below 13.0 g/dL. Either roxadustat (Rox) or enarodustat (Ena) was employed as per the recommended dose adjustments to achieve target Hb levels between 11.0-13.0 g/dL. Anemia-related parameters, including Hb, total iron - binding capacity, and ferritin levels were evaluated along with LDL cholesterol up to 14 months. Adverse events of HIF-PHi were defined as thromboembolic events and malignancy.

Results

Rox and Ena were prescribed to 6 and 3 KTRs, respectively. The mean eGFR was 25.6 mL/min/1.73 m². Hb levels and iron metabolism are shown in Figure (Solid line: Ena and dashed line: Rox). While most of the KTRs demonstrated an increase or maintain in their Hb levels from baseline, 2 of them kept their Hb level below the target ranges. Further, a few of the Rox-treated KTRs showed rapidly increase and decrease in their Hb and ferritin levels, respectively, despite being prescribed the recommended initial dose. Additionally, a drop in LDL cholesterol levels was only observed in the Rox-treated group. Adverse events were not recorded during the observation period.

Conclusion

Based on the recommended dose of HIF-PHi, treatment with Rox resulted in a more rapid increase in Hb levels along with a stronger improvement in iron utilization as compared to that seen in treatment with Ena. For PTA, HIF-PHi would be safe and useful in clinical use.