The conference convened a global panel of individuals with multidisciplinary clinical and scientific expertise to determine best practices and areas of uncertainty in the treatment of anemia in chronic kidney disease (CKD). Elaine Ku, MD (University of California San Francisco, United States), and David C. Wheeler, MD (Centre for Nephrology, University College London, United Kingdom), co-chaired the conference.
In 2012, KDIGO published a guideline for the diagnosis and management of anemia in CKD. Since then, new data from studies assessing emerging therapies for treating anemia have become available. Beginning in 2019, KDIGO planned two Controversies Conferences to review the new evidence and its potential impact on current anemia therapies in clinical practice. This conference report is based on the second of these conferences, held virtually in December 2021, and focused on a new class of agents called hypoxia-inducible factor-prolyl hydroxylase inhibitors (HIF-PHIs). The report provides a review of the consensus points and controversies from the conference and highlights areas for prioritization in future research.
Conference attendees carefully examined the efficacy and safety of HIF-PHIs while considering their impact on current existing therapies, such as iron and erythropoietin treatments. Data from large phase 3 trials across different HIF-PHIs were also scrutinized for their effects on quality of life and use in specific patient populations such as pediatric and kidney transplant recipients. Other novel therapeutic agents, such as sodium-glucose cotransporter-2 (SGLT2) inhibitors, were also discussed.
“HIF-PHIs are just as effective as conventional erythropoietin agents in terms of anemia treatment for people with CKD, regardless of whether they are on dialysis or not," said Dr. Wheeler. "HIF-PHIs also reduce transfusion requirements, but there are lingering concerns about their long-term safety.
"The current data do not suggest that HIF-PHIs will reduce the need for iron supplementation, but all of the trials to date were not designed to answer this question," said Dr. Ku. "Similarly, the hypothesis that HIF-PHIs may be more suitable in patients with chronic inflammation remains untested, which reinforces the need for further studies in this area. Although much trial data have arisen in the last few years, there is still much to be learned about the potential benefits and long-term safety of HIF-PHIs, and we hope the research recommendations summarized in our report will help address some of these unanswered questions."
