Benefits and Risks of Long-Term Use of HIF-PHIs for Anemia of CKD

In several countries, including the United States, hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs) have been approved as supplement or alternative for the clinical treatment of anemia in patients with chronic kidney disease (CKD). Hemoglobin levels are effectively increased via activation of HIF by HIF-PHIs by inducing multiple HIF downstream signaling pathways, suggesting that HIF-PHIs have effects beyond erythropoietin.

In a recent issue of Pediatric Nephrology online [doi.org/10.1007/s00467-023-06031-8], Jia He, MD, and colleagues reported a review of the potential benefits and risks associated with treatment with HIF-PHIs for patients with anemia of CKD.

Results of multiple clinical trials have demonstrated the efficacy and safety of these agents in the short-term treatment of anemia in patients with CKD. However, according to the researchers, there are few data available on the benefits and risks of long-term use of HIF-PHIs (more than 1 year). Areas of concern include the risk of progression of kidney disease, cardiovascular events, retinal diseases, and tumor growth.

The authors said, “This review aims to summarize the current potential risks and benefits of HIF-PHIs in CKD patients with anemia and further discuss the mechanism of action and pharmacological properties of HIF-PHIs, in order to provide direction and theoretical support for future studies.”

Source: Pediatric Nephrology